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HomeMy WebLinkAbout870972Form 3106 -14 (September 1982) 1. Assignee's Name UNITED STATES DEPARTMENT OF THE IN NIENI OF HE INTEEICR BUREAU OF LAND MANA MTOE (A }I1 IIVA El'iE1iT TRANSFER, ASSIGNMENT, ORS FF 77 OF OPERATING RIGHTS IN OIL AN St. 25 AID 9' 30 PART 1 SEE EXHIBIT "A" attached hereto and made a part hereof Address (include zip code) SEE EXHIBIT "A" attached hereto and made a part hereof The undersigned, as owner of 12.5 percent of operating rights in the above- designated oil and gas lease, hereby transfers, assigns, and /or subleases to the assignee shown above, the operating rights in such lease as specified below. 2. Describe the lands affected by this transfer, assignment, and /or sublease (43 CFR 3101,2 -3 or 3101.1 -4) Township 26 North, Range 111 West, 6th P.M. Section 17: All Containing 640 acres, more or less, Lincoln County, Wyoming. 870972 BOOK PAGE 6 6 9 3. Specify interest or percent of operating rights being conveyed to assignee 4. Specify interest or percent of operating rights being retained by assignor 5. Specify overriding royalty interest being reserved by assignor 6. Specify overriding royalty previously reserved or conveyed, if any 54 of 8/8ths; 2% of 7.5% of 8 /8ths 7. If any payments out of production have previously been created out of this interest, or if 9rV'srrch p rXeiikd'gare being reserved under this transfer, assignment, or sublease, attach statement giving full details as to amount, method of payment, and other pertinent terms as provided under 43 CFR 3106. It is agreed that the obligation to pay any overriding royalties or payments out of production of oil created liefein, which, when added to overriding royalties or payments out of production previously created and to the royalty payable to the United States, aggregate in excess of 17 1/2 percent, shall be suspended when the average production of oil per well per day averaged on the monthly basis is 15 barrels or less. I CERTIFY That the statements made herein are true, complete, and correct to the best of my knowledge and belief and are made in good faith. Executed this day of SEP 4. I`.'35 P. O. Box 31515 %Assignor's Signature) H. Chestnut, Pr- .ident Billings, Montana 59107 -1515 (City) (State) (Zip Code) 'tie 18 U.S.C., Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious. fraudulent statements or representations as to any matter within its jurisdiction. Van Heuvel- Assistant Secretary Assignment approved effective OCT.. 1 1985 ante s of 43 CFR 3106. Ci WIOM11,1(.7 THE UNITED STATES OF AMERICA 13 Chief, Oil Gets Section (Title) ,19 GENERAL HYDROCARBONS, INC. Sublette Cutoff (WY -466) FORM APPROVED OMB NO. 1004 -0034 Expires: August 31, 1985 Lease Serial No. W -728 r CLrB effective date October 1, 1981 (Assignor's Address) C R ITIFIED t E- C F I VE, 0 t be t't io official records on fil LINCOLN COUNTY CLERK 0 1 JIM 2 9 H 9: 2 0 f �lN 1' r, °�f l.` FA IT LAN MANAG ENT 12.5% None None ANDREW L. T kg 'pdf5 (Authorized Officer) OC1 2 2 39ti (Date) NOTE: This form may he reproduced provided that copies are exact reproduction .,n heel of both sides of this official ..i pLce vl S•fS ri- PG P /6 c4' Executed this 0 3'70: f72 6 7 0 A. ASSIGNEE CERTIFIES THAT the assignee and all other parties in interest (as defined in 43 CFR 3100.0 -5(b)) in this as- signment are: 1. Citizens of the United States or qualified alien stockholders in a domestic corporation; association of the United States; or any State or Territory thereof; or municipalities. 2. Of the age of majority in the State where the lands to be assigned are located. 3. In compliance with the acreage limitation set forth in 43 CFR 3101.1 -5 and 3101.2 -4. B. ASSIGNEE AGREES That, upon approval of this transfer of operating rights and /or operating agreement (sublease) by the authorized officer of the Bureau of Land Management, he will be bound by the terms and conditions of the lease described herein as to the interests covered by this assignment, including, but not limited to, the obligation to conduct all operations on the leasehold in accordance with the terms and conditions of the lease, to condition all wells for proper abandonment,to restore the leased lands upon completion of any drilling operations as prescribed in the lease, and to furnish and maintain such bond as may be required by the lessor pursuant to the regulations (43 CFR 3104.2). C. IT IS HEREBY CERTIFIED That the statements made herein are true, complete, and correct to the best of undersigned's knowledge and belief and are made in good faith. (Assignee's Signature) Wayne H. Chestnut, President ATTEST: ASSIGNEE'S APPLICATION FOR APPROVAL OF TRANSFER OF OPERATING RIGHTS AND /OR OPERATING AGREEMENT (SUBLEASE) day of SEP 2 1 i995 Secretary fit e.l U.S.C., Section 1001, makes it a crime for any person knowingly and willfully to make to any or agency of the United Mates any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. 1. USE OF FORM Use only for assignment of operating rights (including ,corking interests) in oil and gas leases. If transfer of operating rights is accompanied by an operating agreement, a single copy of such agreement must be submitted with the assignment. If more than one transfer of operating rights is made out of a lease, a separate instrument of transfer is required for each assignment. A separate instrument of assign- ment shall be used for each lease out of which an assignment is made. 2. FILING AND NUMBER OF COPIES File three (3) completed The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following information in connection with information required by this assignment and request for approval. PRINCIPAL PURPOSE Tne information is to be used to process the assignment and request for approval. ROUTINE USES: (1) '17te adjudication of the assignee's rights to the land or resources. (2) Documentation for public information in support of nota- tions made on land status records for the management, disposal, and use of public lands and resources. Transfer to appropriate Federal agencies when concur- rence is required prior to granting a right in public lands or resources. (4)(5) Information from the record and /or the record will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions. PART 11 19 INSTRUCTIONS NOTICE AUTHORITY: 30 U.S.C. et. seq. (City) EFFECT OF NOT PROVIDING INFORMATION If all the in- formation is not provided, the assignment may be rejected. The Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et seq.) requires us to inform you that: This information is being collected pursuant to the law (43 CFR 3106- 3(c)). This information will be used to create a record of lease assignment. Respelse to this request is required to obtaic o benefit.' GENERAL HYDROCARBONS 1982 OIL AND GAS PROGRAM by General Hydrocarbons, Inc., Managing GPnersl Partner (Assignee's Address) P. 0. Box 31515 Billings, Montana 59107 -1515 (State) (Zip Code) and manually signed copies in the appropriate BLM office. A 525.00 nonrefundable filing fee must accompany this assignment. File assignment within ninety (90) days alter date of final execution. 3. EFFECTIVE DATE OF ASSIGNMENT The assignment, if approved, takes effect on the first day of the month following the date of filing of all required papers. If an operator's bond is required, it must be furnished prior to approval of the, assignment. zt tt tt! )I t)( (alive copy O 5 of Li ()E1lclesf reut::(i..; on Slid DEC 2 c. 2000 61 OF LN'1D MANAGEMENT GENERAL HYDROCARBONS 1982X OIL AND GAS GAS PROGRAM by General Hydrocarbons, Inc., Managing General Partner (Assignee's Signature) Wayne H. Chestnut, President ATTEST: OS' 057 A. ASSIGNEE CERTIFIES THAT the assignee and all other parties in interest (as defined in 43 CFR 3100.0 -5(b)) in this as- signment are: 1. Citizens of the United States or qualified alien stockholders in a domestic corporation; association of the United States; or any State or Territory thereof; or municipalities. 2. Of the age of majority in the State where the lands to be assigned are located. 3. In compliance with the acreage limitation set forth in 43 CFR 3101.1 -5 and 3101.2 -4. B. ASSIGNEE AGREES That, upon approval of this transfer of operating rights and /or operating agreement (sublease) by the authorized officer of the Bureau of Land Management, he will be bound by the terms and conditions of the lease described herein as to the interests covered by this assignment, including, but not limited to, the obligation to conduct all operations on the leasehold in accordance with the terms and conditions of the lease, to condition all'Wells for proper abandonment,to restore the leased lands upon completion of any drilling operations as prescribed in the lease, and to furnish and maintain such bond as may be required by the lessor pursuant to the regulations (43 CFR 3104.2). C. IT IS HEREBY CERTIFIED That the statements made herein are true, complete, and correct to the best of undersigned's knowledge and belief and are made in good faith. Executed this day of ASSIGNEE'S APPLICATION FOR APPROVAL OF TRANSFER OF OPERATING RIGHTS AND' OPERATING AGREEMENT (SUBLEASE) t:t 3, B. Van Heuvelen, Assistant Secretary title 18 U.S.C., Section 1001, makes it a crime for any person knowingly and willfully to make to any department or agency of the United itates any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction. USE OF FORM Use only for assignment of operating rights (including working Interests) in oil and gas leases. If transfer of operating rights is accompanied by an operating agreement, a single copy of such agreement must be submitted with the assignment. If more than one transfer of operating rights is made out of a lease, a separate instrument of transfer is required for each assignment. A separate instrument of assign- ment shall be used for each lease out of which an assignment is made. FILING AND NUMBER OF COPIES File three (3) completed PART II 19 INSTRUCTIONS (City) NOTICE The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following information in connection with information required by this assignment and request for approval. AUTHORITY: 30 U.S.C. et. seq. PRINCIPAL PURPOSE Tne information Is to be used to process the assignment and request for approval. ROUTINE USES: (1) The adjudication of the assignee's rights to the land or resources. (2) Documentation for public information in support of nota- tions made on land status records for the management, disposal, and use of public lands and resources. (3) Transfer to appropriate Federal agencies when concur- rence is required prior to granting a right in public lands or resources. (4)(5) Information from the record and /or the record will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions. EFFECT OF NOT PROVIDING INFORMATION If all the in- formation is not provided, the assignment may be rejected. The Paperwork Reduction Act of 1980 (44 U.S.C. 3501 et seq.) requires us to inform you that: This information is being collected pursuant to the law (43 CFR 3106- 3(c)). This information will be used to create a record of lease assignment. Response to this request is required to obtain a benefit. (Assignee's Address) P. 0. Box 31515 Billings, Montana 59107 -1515 (State) (Zip Code) and manually signed copies in the appropriate BLM office. A $25.00 nonrefundable filing feemust accompany this assignment. File assignment within ninety (90) days alter date of final execution. 3. EFFECTIVE DATE OF ASSIGNMENT The assignment, if approved, takes effect on the first day of the month following the date of filing of all required papers. If an operator's bond is required, it most be furnished prior to approval of the assignment. C) h`_. eI ti 671 DriG 7903 OF LAND MAPAGEMENT iq KNOW ALL MEN BY THESE PRESENTS: THAT GENERAL HYDROCARBONS, INC., a Minnesota corporation of 200 Transwestern II, P.O. Box 31515, Billings, Montana 59107 -1515, hereinafter referred to as "Assignor: for and in consideration of the sum of Ten Dollars ($10.00) and other valuable considerations, the receipt and sufficiency of which is hereby acknowledged does hereby assign, transfer, set over and convey unto: General Hydrocarbons 1982 Oil and Gas Program 200 Transwestern II Building P.O. Box 31515 Billings, Montana 59107 -1515 General Hydorcarbons 1982X Oil and Gas Program 300 Transwestern II Building P.O. Box 31515 Billings, Montana 59107 -1515 EXHIBIT "A" To that certain Assignment of Record Title in Oil and Gas Lease Number W- 72845, dated EP -..1,..et /7" 1984 an undivided 8.463542% an undivided 4.036458% 672 r n igt i O8'7U9't STATE OF MONTANA COUNTY OF YELLOWSTONE GENERAL HYDROCARBONS, INC. ss. BEFORE ME, the undersigned authority, in and for said .county and state, on this day personally appeared WAYNE H. CHESTNUT, known to me to be the person and officer whose name is subscribed to the foregoing instrument and acknowledged to me that the same was the act of the said General Hydro- carbons, Inc., a corporation, and that he executed the same as the act of such corporation for the purposes and consideration therein expressed, and in the capacity therein stated. GIVEN UNDER MY HAND AND SEAL OF OFFICE THIS 1984. No tary public Jo Ann Uukart NOTARY Pt' for t!lc Male of tMoc Ana licsi; ?irr a t Pillint;s, bioula:ra My Co:nuti: ;si „r, x ti 19'_'7 My Commission Expires day of r.:c 2f03 6r7 3 co r:.� Gr++ -a fS• tY, fl.. -J (4- 1 r` 0870972 STATE OF MONTANA COUNTY OF YELLOWSTONE On this day of 19 before me, a Notary Public, personally appeared WAYNE H. CHESTNUT, to me personally known, who, being by me duly sworn, did acknowledge before me under oath that he is the President of General Hydrocarbons, Inc., the corporation that is the general partner of the partnership named in the foregoing instrument, that he executed said instrument on behalf of said corporation by the authority of its Board of Directors, and that said instrument is the free act and deed of said corporation as said general partner. NOTARY PUBLIC Jo Ann Dukart GENERAL HYDROCARBONS 1982 OIL AND GAS PROGRAM A Montana Limited Partnership ss GENERAL HYDROCARBONS 1982X OIL AND GAS A Montana Limited Partnership NOTARY PUBLIC for the Str,te of ^;'outima Residing at Billings, ?'1 i.na (41y Commissiuu Expires Aug,. ti, 1 J °7 My commission expires PRO( 1M NOTARY PUBL for the Stn of Montana Residin a1 Billinis, P n K zi, My Commission Exptrc: Aug. 6, VW 7 NO T -7") A RY PUBLIC Jo Ann Dukart My commission expires 674 c3 r•, STATE OF MONTANA ss. COUNTY OF YELLOWSTONE On this day of 19 before me, a Notary Public, personally appeared WAYNE H. CHESTNUT, to me personally known, who, being by me duly sworn, did acknowledge before me under oath that he is the Presidbitt of General Hydrocarbons, Inc., the corporation that is the general partner of the partnership named in the foregoing instrument, that he executed said instrument on behalf of said corporation by the authority of its Board of Directors, and that said instrument is the free act and deed of said corporation as said general partner.