HomeMy WebLinkAbout892634FORM 30o0-3
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
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.
FORM APPROVED
OMB NO. 1004-0034
Expires: September 30, 1998
Lease Serial No.
WYW-131416
Lease Effective Date
(Anniversary Date)
February 1, 1994
New Lease Serial No.
Assignee*
Street
City, State, ZIP Code
PART A: ASSIGNMENT
EnCana Energy Resources, Inc.
950 17th Street, Suite 2600
Denver, Colorado 80202
BOOK, ~3~pR PAGE 4 9 6
RECEIVED
LINCOLN COUNTY CLERK
*If more than one assignee, check here 1'] and list the name(s)andSdge'~_(~
This record title assignment is for: (Check one) ~ Oil ~d G~ Lease, or
Interest conveyed: (Check one or both, as appropriate) ~ Record Title, ~ Overriding RoyalW, payment out of production or other similar
imerests or
2. This assignment conveys the following interest:
Land Description Percent of Interest Percent of
Additional space on reverse, if needed. Do not submit documents or agreements other Owned Conveyed Retained Overriding Royalty
than this form; such documents or agreements shall only be referenced herein, or Similar Interests
Reserved Previously
reserved
or convevcci
a b c d e f
Township 20 North, Range 113 West, 6th' p.'M. 100.00% 100.00% none 7.50% none'
Section 4:SW/4
containing 160.00 acres
Lincoln County, Wyoming
FOR BLM USE ONLY-- DO NOT WRITE BELOWTHIS LINE
UNITED STATES OF AMERICA
This assignment is approved Solely for administrative purposes. Approval does not Warrant that either party to [his assignment holds legal or
equitable title to this lease.
[] Assignment approved for above described lands; [] Assignment approved for attached land description
Assignment approved effective [] Assignment approved for land description indicated on reverse
of this form.
By
(Authorized Officer) (Title) (Date)
Part A (Continued) i ~:'~: :-:: :::)NAL SPACE for Names and addresses of addmo: :;t:::::' .ecs tn Item No. 1, if needed, or for Land Descripti,..: i '..'%. 2, if needed.
State of Colorado }
County of Denver }
This instrument was acknowledged before on May 13, 2003, by Michael W. O'Shaughnessy, President
of Lario Oil & Gas Company, a Delaware corporation, on behalf of said corporation.
Witness my hand official seal.
Duane L. Haley
8055 East Tufts Avenue #1200
Denver, Colorado 80237
NOTARY PUBLIC
STATE OF COLORADO.
My Commission Expires 8/2/2006
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
law 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 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 D/strict 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 parties holding an interest in the assignment are
other,vise 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 (O Assignee is not in violation ti' sec. 41 of the
Mmeral Leasmg 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 (¼) 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 13th day of May
2003
Lario Oil & Gas Company
Assignor
Michael W. O'Shaughrttss?Pres~ql~nt
301 South Market Street
Wichita, Kansas 67202
(City) (State) (Zip Code)
Executed this 15th dayof da'j'y 2003
f nc.
Oonithan L. Grannis, ^ttorney-in-Fact
950'Seventeenth Street, Suite 2600
Denver, CO 80202
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
complcnng and reviawing the tbrm. Direct COlllments regarding thc burden estimate or any other aspect ti'this tbnn to U.S. Dcpanracnt of thc Interior, Bureau or'Land
Management, Bureau Clearance Officer, (DW-I IO), Denver Federal Center Building 40, P. O. Box 25047, Denver, CO 80225-O047 and the Otticc ot'lVla~agcmcnt and
Budget. PapcrworkRcduction Project (1UU4-UU34). Wa/hingtoa, D.C. 205U3.
Title 18 U.S.C. Sec. 1001 makes it a crime for any person knowingly and willfully to make to any Depamnant or agency tithe United States any false, fictitious or fraudule~lt
statements or representations as to any matter widfin its ,jurisdiction.
· U.S. GPO 1997:573-004141047