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HomeMy WebLinkAbout890886Form3000-3 (January 1999) 4 UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT ASSIGNMENT OF RECORD TITLE INTEREST IN A LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES 9 _ PR PAGE___o 2 '[ Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.) Act for Acquired Lands of 1947 (30 U.S.C. 351-359) Geotherlrml'-Steam Act of 1970 (30 U.S.C. 100J - 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. FORM APPROVED OMB NO. 1004-0034 Expires: December 31,2001 Lease Serial No. wyw 150469 Lease Effective Date (Anniversary Date) dune 1, 2000 New Serial No. PART A: ASSIGNMENT Assignee* Stone Energy Corporation Street 1801 Broadway., Suite 700 City, State,ZIp_Code Denver,Colorado 8020~ 9 0 8 8 6 *lfmore than one assignee, cbeckhere [] and list file name(s) and address(es) of all on a separate attached sheet of paper This record title assignment is for: (Check One) RECEIVED LINCOLN COUNTY CLERK [] Oil and Gas Lease, or additional assignees on the reverse of this .... I'!Z ......... Geothermal Le~e form or Interest conveyed: (Check one or both, as appropriate) [] Record Title, [] Overriding Royalty', payment out of production or other similar interests or payments 2. This assignment conveys the following interest: Land Description Percent of Interest Percent of Additional space on reverse, it'needed. Do not submit documents or agreements other than Owned Conveyed Retained Overriding Royalty .~/ihis fom~; such documents or agreements shall only be referenced herein, or Similar Interests Reserved Previously Reserved /¢/ Or conveyed A b c d e f ToWnship 25 North, Ranqe 112 West, 6'h P.M. 100% 50% 50% 0% of None Section 18: Lots 1-4, W/2E/2, E/2W/2 8/8ths Section 19: Lots 1-4, W/2E/2, E/2W/2, SE/4SE/4 Section 30: Lots 1-3, E/2, E/2NW/4, NE/4SW/4 Lincoln County, Wyoming Containing 1,217.15 acres, more or less Subject to the reruns and conditions of the certain Farmout Agreement, dated effective August 1, 2000 by and between Marathon Oil Company and Basin Exploration, Inc., as amended FOR BLM USE ONLY - DO NOT WRITE BELOW THIS LINE UNITED STATES OF AMERICA This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assignment holds leffal or equitable title to this lease. [] Assignment approved for above described lands; Assignment approved effective [] Assignment approved for attached land description [] Assignment approved for land description indicated on reverse of this form. By (Authorized Officer) (Title) (Date) 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. STATE OF OKLAHOMA § § ss. COUNTY OF OKLAHOMA § The foregoing instrument was acknoWledge,d before me by , "~, ~&'~-fi, ~---~'-r~fi4~- for MARATHON OIL COMPANY, this ~'~--4~-jday of June, 2003//' My Commission Expires: , as AttOrney-in-Fact Witness my hand an~hoffidal seal. ~/£"~ Notary .... ~: PHYLLIS A. PACE /'~ "".. Oklahoma County ~ ~SE.,.A, L.,) ! Notary Public in and .for \ ..~/ State of Oklahoma ..... ~.u..~.,.,," My commission expires Feb. 28, 2004. PART B: CERTIFICATION AND REQUEST FOR APPROVAL l. The Assignor certifies as owner Of an interest in the above designated lease tbat he/she hereby assigns to the above assignee(s) the rights specified above~ 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 cbargeable interest, direct or 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 m oil and gas options), or30 0,000 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 m 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 regulatious (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation requiremants tbr all Federal oil and gas lease holdings as required by sec. 17 (g) of the Mineral Leasing Act; and (f) Assignee is not iu violation of sec. 41 of the Mineral Leasing Act. 3. Assignee's signature to this assignmeut constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein. For geotbermal 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 assigmncnt is added to all previously created overriding royalties (43 CFR 3241). 1 certify that thc statements nmde herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith. *Effective ~twee~ayo~e Qarties Au_qust,2(~ 0~000 Executed this I~ dayof ~W nfl Executed this -June t ,20 03 Name of Assignor as shown on current Lease Marathon Oil Company Assignor !:'.~ , or (Signatm,~[ ~ ~ Attorney-in-fact .. ", D. X~.73~b~t~' (Signature) Expressway (Assignor's Address) Oklahoma City, Oklahoma 73132 Assignee or Attcrr,,W in Fact Michael E. Cuba. Denver District Land Manager (City) (State) (Zip Code) Public reporting burden for this form is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding t be burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0034), Bureau Clearance Officer, (WO-630), Mail Stop 401 LS, 1849C Street, N.W. Washington, D.C. 20240. Title 18 U.S.C. Sec. 1001 makes it a crime Ibr any person knowingly and willfully to make to any Department ~r agency of the United States any false, fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.