HomeMy WebLinkAbout894801Form 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)
FORM APPROVED
OMB NO. 1004-0034
Expires: August 31, 1989
Lease Serial No.
WYW-14 3718
Lease Effective Date
(Anniversary Date)
December 1, 1997
New Serial No.
Type or print plainly In ink and sign in ink.
PART A: ASSIGNMENT
R'EOEWtL~, ",
LINCOLN COUNTY CLERK'
Assignee* BASELINE MINERALS
Street 1645 Court Place, Suite 422 03 OCT
city, State, ZIP Code Denver, COlorado 80202 r~gh 8
*If more than one assignee, check here [] and list the name(s) and address(es) of all additional assignees on
separate attached sheet of paper.
This record title assignment is for: (Check. one) ~ Oil and Gas Lease. or [] Geothermal
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 followin[~ 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
· or Similar Interests
this form; such documents or agreements shall onJy be referenced herein.
Reserved Previously
rose.ed
or conveyed
a b c d e f
Sec 24: All
Containing 2,422.33 acres, more or less
Lincoln COunty, Wyoming
FOR BLM USE ONLY--DO NOT WRITE BELOW THIS LINE
' UNITED STATES OF A~ER.ICA
This assignment is appro~od solely for administrative purposes. Approval do~ not warrant flsa1 either part), to this assignment bolds legal or
equitable title to (his 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. ' ''~ ":
B.y
Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. I, if needed, or for Land Description in Item No. 2, if
~ x ded
A~sl~or a~ l~as~ ~lXZy (60} d&y~ In advance of ~he proposed s~render or relln~lshl~nt da~.
~lll be 11~1~ to ~ cash constdera~ofi paid for ~ls ~e~se a~l~men~.
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
I. The assignor certifies as'owner of an interest in thc 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 or. ganized under thc 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 thc laws of thc 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 arc otherwise in compliance with thc 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 (0 Assignee is not in
violation of sec. 41 of the Mineral Leasing Act.
3. Assignee's signature lo this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restriclions pe~ai.n, ing lo 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 tale of royalty
due to the United States when this assignment is added to all previously c?eated 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 arc made in good faith.
Executed this 18th day of" August . t9 2003.
Kay Papulak
Name of Assignor as s~;own on c~n~nt lease Trachyte Oil Company
~ / . / / / Please type or print
or Kay P La .am
416 10th Avenue~.
(Assig.or's Address)
Salt Lake City, Utah 84103
(City) (State) (Zip C~e)
Executed this
7~g q~f'~ dayof
' ~ (SignatUre) ~
(Signature)
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, ficlitlous or fraudulent
statements or representations as to any matter within its jurisdiction.
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