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Home My WebLink About894799Form 3000-3 (June 1988) 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: August 31, 1989 Lease Serial No. WYW-143134 Lease Effective Date (Anniversary Date) September 1, 1997 New Serial No. PART A: ASSIGNMENT Assignee* BASELINE MINERALS Street 1645 Court Place, Suite 422 Ci~, State, ZIP Code Denver, Colorado 80202 *If more _than one assignee, check here 1--] 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) [] Oil and Gas Lease, or [] Geothermal Lease Interest conveyed: (Check one or both, as appropriate) I-~ Record Title, [] Overriding Royalty, payment out of productipn or other similar interests or payments 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 than Owned Conveyed Retained Overriding Royalty this form; such documents or agreements shall only be referenced herein, or Similar Interests Reserved Previously reserved or conveyed T 23 N, R 115 W, 6th PM Sec 13: NE¼, N%NW¼, SE¼NW¼, Sec 25: All il. LIN:O DLN OOU ~Y'!,OLERK Containing 2,520.00 acres, more or iess89 Lincoln County, Wyoming 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 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 Part A (Continued): ADDITIONAL SPACE for Names and addres~s of additional assignees in item No. 11 if needed, or for Land Description in Item No. 2. if needed. ~lthln fifteen (15) days after recelp~ of such notlea fro~ ~$lgnse sleet to r~ac~l~ said leass to such lands, STATE OF UTAI~ ) / // PART B: CERTIFICATION AND REQUEST FOR APPROVAL I. 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, nationaJs, 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 cove.red 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 31,200 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 see. 4.1 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 (~,~) 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). ! 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 18th dayo~. August ,:1~ 200~3.:. / Name of Assignor~shown on current~e, ase Trachyte//Oxl Company ~eszaen~ ~ (Signam~) or Attorney-in-fact (Signature) P. O. BOX 11206 Executed this. /~ day of_ _/~~ , ~)'-~ ~ (Signature) (Assignor's Address) Salt Lake City, Utah 84147-0206 (City) (State) (Zip Code) < Title 18 U.S.C. Sec. I001 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 wilhin its jurisdiction.