HomeMy WebLinkAbout868490Land Description
Percent
Owned
b
of Interest
Conveyed
c
Percent of
Overriding Royalty
or Similar Interests
Additional space on reverse, if needed. Do not submit documents other than this form;
such documents should only be referenced herein.
a
Retained
d
Reserved
e
Previously
reserved
or conveyed
f
T22N R115W Lincoln County,
Wyoming
100%
100%
below
100%
above
5
1/2
33NDISS`d HOI
Sec. 27 W2E2, W2;
3,000'
3,000'
31 E2E2;
32 All; 33 All; BOOK
PR PAGE 41
t
R F l \1 s
f
t�
34 All;
2,560 Total acres
0
tine
Pt`0
Form 3000 -3a
(May 1987) Ij
t. r~
MA 9 OCR
00 t 1E `1
By
1. Transferee (Sublessee)
Street
City, State
Zip Code
Additional Transferees
Baseline Minerals, Inc.
1645 Court Pl., Suite 422
Denver, Colorado
'80202
This transfer is for: (Check one) 1I Oil and Gas Lease, or i._.i ti.:eothermal Lease
Interest conveyed: (Check one or both, as appropriate) XXOperating Rights (sublease) Overriding Royalty, payment out of production or other
similar interests or payments
2. This transfer (sublease) conveys the following interest:
THE UNITED STATES OF AMERICA
This Transfer is approved solely for administrative purposes. Approval does not warrant that either party to this transfer holds legal or equitable
title to this lease.
AUG 0 1 2000
T ransfer Approved Effective
/S1 Carnes S. tfilt
(Authorized Officer)
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 U.S.C. 351 -359)
Geothermal Steam Act of 1570 (30 U.S.C. 1001 -1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (P.L. 96 -514)
Type or print plainly in ink and sign in ink.
PART A: TRANSFER
FOR BLM USE ONLY
ut...P.!D LAW EXA:6 NER
(Title)
FORM APPROVED
OMB NO. 1004 -0034
Ex 31, 1989
Lease Serial No.
WYW4.148118
SEP 8
(Date)
Part A (Continued): ADDITIONAL SPACE for Land Description in Item No. 2, if needed.
U8(18
Executed this
(City)
STATE OF Utah
COUNTY OF Salt Lake
On this 20th day of June, 2000, personally appeared before me Jake Harouny, whose identity' is personally
known to me, and who by me duly sworn, did say that he is the President of Medallion Exploration, a Utah
Corporation and that said document was signed by him in behalf of said Corporation by Authority of its
Bylaws and acknowledged to me that said Corporation executed the same.
u
My Commission Expires: 1/15/2002
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.
Midvale Utah
day of 6/7,7, -i9�Z lJ
(Transferor's Address)
(State)
SS
ACKNOWLEDGMENT
84047
(Zip Code)
Transferor
Attorney -in- fact /1
ry Public
4 0
0_ 03
g
at9
p N N O'
w �9 rn
1 o c a rrt
o%mvn g
11. am um me ma ea
(Signa ire)
M7S�1a]S TIC. J e `dares President
Executed this day of 19 Attorney -in -fact
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 10 any matter within its jurisdiction.
*U.S.GPO:1987- 181 423/64101