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Home My WebLink About868493Form 3000 -3 (June 1988) a %i' 'r GE0 td i 00 11 2.1 9100 ASSIGNMENT OF RECORD TITLE INTEREST IN A R W N U LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES Cli PART A: ASSIGNMENT 1. Assignee* Baseline Minerals, Inc. Street 1645 Court Place, Suite 422 City, State, ZIP Code Denver, Colorado 80202 *If more than one assignee, check here and list the name(s) and address(es) of all additional assignees on the reverse of this form or on a separate attached sheet of paper. This record title assignment is for: (Check one) iji Oil and Gas Lease, or Geothermal Lease Interest conveyed: (Check one or both, as appropriate) J Record Title, Overriding Royalty, payment out of production or other similar interests or payments 2. This assignment conveys the following interest: Percent of Interest Owned b 100% Conveyed c 3 100 Retained d NONE Reserved e 5% R`WC r (.!1i; ...i. c:. Additional space on reverse, if needed. Do not submit documents or agreements other than this form; such documents or agreements shall only be referenced herein. T 23 N, R 115 W, 6th PM Sec 20: ANA, SW's Sec 22: All Sec 29: W1 Land Description Containing 1,200.00 acres, more or less Lincoln County, Wyoming By a a i rmen E. Lovett UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT 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 1970 (30 U.S.C. 1001 -1025) Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) Type or print plainly in ink and sign in ink. BOOK s PR PAGE FOR BLM USE ONLY —DO NOT WRITE BELOW THIS LINE UNITED STATES OF AMERICA Lease Serial No. WYW- 135961 Lease Effective Date (Anniversary Date) April 1, 1995 New Serial No. Assignment approved for attached land description FORM APPROVED OMB NO. 1004 -0034 Expires: August 31, 1989 Percent of Overriding Royalty or Similar Interests Previously reserved or conveyed EIVED z This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds legal orili eqq table title to this lease. CO Assignment approved for above described lands; Assignment approved effective AUG 'a 21 ,',p Assignment approved for land description indicated on reverse Lt. of this form. Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, if needed, or for Land Description in Item No. 2, if needed. VVti81tJV REASSIGNMENT OF LEASE AGREEMENT: If Assignee desires to surrender or relinquish said lease in whole or in part, Assignee shall mail an appropriate notice to Assignor at least sixty (60) days in advance of the proposed surrender or relinquishment date. If Assignor desires to reacquire such leases as to the lands surrendered, Assignor shall notify Assignee within fifteen (15) days after receipt of such notice, and thereupon Assignee shall reassign such interest to Assignor; if Assignor does not within fifteen (15) days after receipt of such notice from Assignee elect to reacquire said lease to such lands, Assignee shall then have the right to surrender such interest. Failure of Assignor to respond within the time allowed shall be an election not to reacquire said interest. Any reassignment under the terms of this paragraph shall be free and clear of all burdens, encum— brances or outstanding interests other than those existing on the date hereof. Assignee's liability hereunder shall be limited to the cash consideration paid for this lease assignment. COUNTY OF SALT LAKE tltttts STATE OF UTAH Notary PubllO in e 6th day of April, 2000, personally appeared before me PAMELA K. •u k, who being by me dul worn did say that sh xecuted 8133 Foxhil w1that and foregoing instr Salt Lake City, Utah 84115 MY Commisslorimi t ion Expires: January 1, zigu3 State ;At Utah gam am egeare :a. PART B: CERTIFICATION AND REQUEST FOR APPROVAL 1. The assignor certifies 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 certifies 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 association 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 either public domain or acquired lands, do not exceed 200,000 acres in oil and gas options or 246,080 in oil and gas leases in the same State, or 300,000 acres in leases and 200,000 acres in options in each leasing District in Alaska, 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 parties 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 ('k) 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. Executed this 6th day of ADril g*X 2000 Executed this day o Name of Assignor as s own on curre lease Kay Palm, 1 ak Please type or print 9- Assignor Assignee t or Kay Paulak (Signature) Attorney -in -fact At ey -in -fact (Signature) (Signature) 416 10th Avenue (Assignor's Address) Salt Lake City. Utah 84103 (City) (State) (Zip Code) NOTARY ss. ACKNOWLEDGMENT Not •l s i•ing in Salt a. Ci y, Utah h me s (Signat President- or 427 2.07n.) 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.,