HomeMy WebLinkAbout878051Form3000-3 '~:, UNITED STATES FORM APPROVED
(January 1996) DEP.q.,x i'MENT O1;' THE INTERIOR OMB NO. 1004-0034
,' .: ~ ~- :', . BUREAU OF LAND MANAGEMENT · . Expires: September 30, 1998
:;,, .... ' ~. l~li[l ¥="~\[{~' t. EASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES
,,'~ F.J I_~ SEE ATTACHED
· Lease Effective Date
(~[ [~ 2q [g ~; {~ Mineral Leasing Act of1920 (30U.S.C. 181 etseq.) (Anniversa~Date)
. Act for Acquired L~ds of 1947 (30 U.S.C. 351-359) SEE ATTACHED
.... , ~" ?~ Geothemal stem Act of 1970 (30 U.S.C. 1001-1025)
~':~ ~; ~ [~ .[ '~ep~mnt of the Interior Appropriations Act FiscM Ye~ 1981 (42 U S C 6508~
PART A: ASglGNMENT
~. aa~ig~st~t P. PETAL O. BoxEXPLOItATION 5083 LLC BOOER : PAGE~
ci~, State. z~ Code DE~ER, CO 80217-5083
· 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
separato aRached sheet of paper.
This record title assignment is for: (Check OhO ~ Oil and Gas Lease, or ~ Geothemal Lease
Interest conveyed: (Chegk one or both, as qppropriate) ~ Record Title, ~ Ove~iding Royal~, payment out"of production or other similar
interests or payments ,, .
2. This assignment conveys the following interest:
Land Description Percent of Interest Percent of
Addi~onal space on revers,, if needed. Do not submit dooum*nts or a~eements other finn Owned Conveyed Retained Ove~iding Royal~
this fora; such doouments or agreements shall only be referenced herein, or Similar Interests
Rescued Previously
reserved
or conveyed
a b e d e 'f
SE[ A~AGHHD EXHIBIT 'A' , 0.5000%' 0.5000% NONE
FOR BLM USE ONLY -- DO NOT WRITE BELOW THIS LINE
. U~TED STATES OF AMERICA
This assignment is approved solely for administrative purposes. Api)roval does not warrant that either party to this assignment holds legal or
equitable rifle to this lease.
[] Assignment approved t'or above described lands; [] Assignment approved for attached land description
Assignment approved effectige [] Assignment approved for land description indicated on reverse
of this form.
By.
(Authorized Officer) (Title) (Date)
Pm A (Continued): ADDITIONAL SPACE for Names anti addresses of additional assignees in Item No. l, if needed, or for Land Description in Item No. 2, if needed.
SYAYE OF COLORADO )
COUNTYr¢/OF DENVER ¢ )...1_
On tbs~///I day of(,'¢{'~r, 'V¢('¢' , 2001, before me personally appeared, Dennis W. Yookim, to me personally known, who, being
d~m did S~v th¢"he is the Manager of PETROTA LIMITED LIABILITY CO. and that the seal affixed to said instrument
by
me
was
signed and sealed on behg~f'of~' said PETROTA LIMITED LIABILITY CO., and said Dennis W. Yockim acknow~edgeed said instrument
to be the free act and deed'of said corporation.
WI'IN~ y.ha~,a~[al this %day of ......
P. O, Box 5083
Denver, CO 80217-5083
PART B: CERTIFICATION A~D REQUEST FOR APPROVAL
1. The A*~ignor e~ifies ~ owner of an interesi in the above designated tease that heshe hereby ~signs to the above ~signee(s) the rlghB s~ecifie3 above.
2. A~ignee c¢~ifies ~ foBow~: (a) Assignee i~ a cili~en ef the United Stales; ~ associallon of such ~itiz~ns; a municipally; or · corporation org~ized under lhe
of the United 8tares or of ~7 Stale or lerritow thereaf For the ~ssignmenl of NPR-A leases, ~signee is a citizen, nationat, or resident alien of the Uniled Stales or
~soeiation of such citizens, nationals, resident alien~ or privale, pubtic or municipat eo~oralion~; (b) Assignee i~ not considered a mi*mr under the law~ of the State
in which the lmdl covered by thi~ ~signment ~e loemed; (e) Assignee's eh~geable interem, direct md indireel, in each public domain ~d acquir~ l~ds sep~ately in
· e sine.State, do not exceed 246,080 acres in oil ~d gas teases (of which up to 200,000 acres m~y be in oil md ga~ options), or 300,000 acres in leases in *ach le~ing
District in Al~ka of which up to 200,000 acres may be in options, if this is ~ oil md gas Ieee issued in accord~ce with ~e Miner~ Leasing Act of 1920, or 5 ] ,200
acres in my one S~ate if this is a geothermal le~; (d) All pmlts holding m interes~ in ~he assignment ~e othemise in eompli~ce with the regulmions (4~ CFR Group
3100 or 3200) ~d the authorizing Act~; (e) A~signee is in complimee with reelmation requirements for all Federal oil ~d gas leas~ holdings as required By ~ee. 17(8)
of the Mineral .Leasing Act; aha (0 Assignee is not in ¥iolation of sec. 41 of the Mineral Le~ing Act
~. As~i~ee'~ signature to this assignment constitutes ~ccept~ce of all applicable terms, conditions, stipulations ~d restrictions pe~aining to the I~e described herein.
For gemh~rmal assignments, ~ overriding rogal~ may not b~ less th~ one-fourth 0A) of nne percent of the value of output, nor 8rester thru 50 pereenl of the rate of
due to the United States when this ~signm~nt i~ added to all previously create4 overriding royalties (4~ CFR ~241).
1 ceffify that the Statements made herein by me are tt_~e, complete, and co~ect to the best of my knowledge and belief m~d are made in good fa th
But, effective August 1, 2001./] ( ['~ .
P~ I/ ./. ' ~' / P~ase¢¢eorprint /~ t~ /~/ Hanager
or - (Signatm'e) or ' t - - r Signs
t · ' V anthgny R. Maye¢, ~r[sident
ARomey-in-fact Dennis W~ockim ~ ARomey-in-fact
~ (SignatUre) (Signature)
P. O. BOX 477
(AsJigno~ Address)
Williston ND 58802
(City) (State) (%ip Code)
Public repoRing burd*n for this form i~ e~timated to averag~ ~0 miaute~ per respor,~e including ~e time for reviewing instmcdon~, gath~ing ~d mainlain[ng dat~ and
complofing ~d ~v[~w[ng th= form, Dir~cl comment~ r~garding lhe bu[den ~limm~ or ~I other ~p~cl of lhi~ form to O~S. Dep~menl of the Inledor, Bureau of L~d
M~agement, Bureau Cle~ce Officer (DW-I 10), Denvtr Federal Center, Building 40, P.O Box 25047, D~nv*r, CO 80225-0047 ~d ~ Office ofM~agemem ~d
Budget, Pape~ork Reduc~on Project (1004-0014), Wa*hington, D.C. 20503.
Tillm ~ 8 U.S.C ~ 1001 m~k~ it a ~rim= for ~y p~r~o~ knowingly ~d willfidly ~o make ~o ~y D~p~m=nt o~ ag~nc~ of th* Uniled Slate~ ~y faire, fictidou~ or
~tatement~ or repre~entation~ ~ ~o ~y mauer whhin its jurimdiction.
LEASE NO.: WY5740 PASCALI PROSPECT
LESSOR: USA WYW 136846
LESSEE: PETRAL EXPLORATION LLC
LEASE DATE: 07/01/95
RECORDED: BOOK 384 PAGE 342
DESCRIPTION: TOWNSHIP 23 NORTH, RANGE 113 WEST, 6~ pM.
SECTION 32: NE/4, E/2NW/4
SECTION 33: LOTS 1-12, NE/4, NE/4NW/4, S/2NW/4
SECTION 34: LOTS 1-4, N/2, N/2S/2
SECTION 35: LOTS 1-4, N/2, N/25/2
LINCOLN COUNTY, WYOMING ~
LEASE NO.: WY5613 BALLERINA PROSPECT
LESSOR: USA WYW 131931
LESSEE: PETRAL EXPLORATION LLC
LEASE DATE: 04/01/94
RECORDED: BOOK PAGE .~
DESCRIPTION: TOWNSHIP-21 NORTH, RANGE 113 WEST, 6T~ PM
SECTION 2: LOTS 1-4, S/2N/2, S/2
SECTION 12: LOTS 1-4, W/2E/2, W/2
SECTION 26: LOTS 3-6, W/2SW/4, SE/4SW/4
LINCOLN COUNTY, WYOMING
LEASE NO.: WY5678 BALLERINA PROSPECT
LESSOR: USA WYW 134458
LESSEE: P~--TRAL EXPLORATION LLC
LEASE DATE: 11/01/94
RECORDED: BOOK ~ PAGE
DESCRIPTION: TOWNS. H.Ip 21 NORTH, RAN. GE 113 WEST, 6T~ PN
SECTION 10: LOT 1, N/2, N/2SW/4, SE/4SW/4, SE/4
SECTION 16: LOTS 1-7
SECTION 30: LOTS 1-4, 6-9, E/2NE/4, N/2SE/4
LINCOLN COUNTY, WYOMING