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Vi i 6Z SM Q V NI IS32131NI 31111 O JO3 21 AO 1N3INNOISSV .LN3IJ30VNV11 QNd'1 30 11V3131-18 �N3W3�J�� w w i 1 `i 2101H3.LN1 3H1 JO .LN3111121Vd3a 23 —143"14 Y ,1 .i S3.LV.LS (1311N11 :(e (Z66I Ja9o110) (•OOOE uuod Part A (Continued): ADDITIONAL SPACE for Nam. addresses of additional assignees in item No. 1, if needed, o for Land Description in item No. 2 if needed ACKNOWLEDGMENT STATE OF e1, COUNTY OFD. Des c4, The foregoing instrument was acknowledged before me this day of My Commission Expires: p, a--`j 03 Executed this 110 day of 4A3A54" Name of Assignor as shown o urrent lease Assignor: Or Attorney -in -fact (Signature) 63340 Silverado Drive (Assignor's Address) Bend. OR 97701 (State) (Zip Code) MY 2000, by Harold David Morales. IC PART B: CERTIFICATION AND REQUEST FOR APPROVAL {MLI U HIE (1`11I3f (qQ9? ::pit F A OF LAND MANAGEMENT" 00 AUG 29 AM 9: 00 NOT/ P AV' W OMING NO. 319 ='61 1. The Assignor cenifles as owner of an interest in the above- designated lease that he/she hereby assigns to the above assignee(s) the rights specified above. 2. Assignee terrifies as follows: (a) Assignee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under the laws of the United States or of any State or territory thereof. For the assignment of NPR -A leases, assignee is a citizen, national, or resident alien of the United States or associations of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Assignee is not considered a minor under the laws of the State in which the lands covered by this assignment are located; (c) Assignee's chargeable interests, direct and indirect, in each public domain and acquired lands separately in the same State, do not exceed 246,080 acres in oil and gas leases (of which up to 200,000 acres may be in oil and gas options), or 300,000 acres in leases in each leasing District in Alaska of which up to 200,000 acres may be in options, if this is an oil and gas lease issued in accordance with the Mineral Leasing Act of 1920, or 51,200 .acres in any one State if this is a geothermal lease; (d) All parries holding an interest in the assignment are otherwise in compliance ■with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation requirements for all Federal oil and gas lease holdings as required by sec. 17(g) of the Mineral leasing Act: and (f) Assignee is not in violation of sec. 41 of the Mineral Leasing Act. 3. Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein. For geothermal assignments, an overriding royalty may not be less than one -fourth (1/4) of one percent of the value of output, nor greater than 50 percent of the rate of royalty due to the United States when this assignment is added to all previously created overriding royalties (43 CFR 3241). I certify, that the statements made herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith. 2000 Executed this VID MORALES Assignee: Assignee: nr Attorney -in -fact Assignee: Attorney -in -fact arold David Morales (Si nature) ,4 tY day of /ii1 1/A%f ;f BASELINE 11NERALS, );`IC. (Signature) eph W. Theme sident (Signature) (Signature) 2000 Public reporting burden for this form is estimated to average 30 minutes per response including the lime for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U .S. Department of the Interior, Bureau of Land Management, (Alternate) Bureau Clearance Officer (WO -771), 1849 C Street, N.W., Washington, D.C. 20240, and the Office of Management and Budget, Paperwork Reduction Project (1004- 0034), Washington, D.C. 20503 Title 18 U.S.C. Sec. 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 or fraudulent statements or representations as to any matter within its jurisdiction.