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HomeMy WebLinkAbout894802Form 30004 (October 1992) 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.) FORM. APPROVED OMB NO. 1004-0034 Expires: July 31, 1995 Lease Serial No WYW-143718 Act for Acquired Lands of 1947 (30 U.S.C. 351-359) L6.~se]~,ctrve Geothermal steam Act of 1970 (30 U.S.C. 1001-1025) Date Depa~ment of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508) ~., l~pa or print plainl~ In Ink and ai~n~h~ing2 :}~' . . PART A: ASSIGNMEN~---~,-,-' ~..:"~'.~(; 1. Assignee* Condor Exploration, LLC Street 7720EBelleviewAvenue, SuiteB-102 : ,'~0K~O i,~bAOE Ci~, State, ZIP Code Greenwood Village, CO 80111 ~ *If more than one transferee, check here [ ] and list the name(s)" '' :" and address(es)of all .dd,tmaa, transfire.s sheet of paper. ~, This tr~sfer is for: (Checkone) [X] Oilal,dGasLe~e, or []Geotherma~h 8 0 Interest conveyed: (Check one or both, as appropriatO [ X] Record Title. [ X ] Ovemding Royal~, payment out of production or other simil~ interests or paymen~ JEANNE 2. This ~signment conveys the followin¢ interest: land Description Percent of Interest Percent of Overriding Royalty Additional space on reverse, if needed. Do not submit documents or agreements other than this Owned Conveyed Retained Or Similar interests form; such documents or agreements shall only be referenced herein. Reserved Previously reserved or conveyed A b c d e f Township 24 North, Range 115 West, 6'~ P.M. 100% 100% 0% 0.3000% Of record Section 1: Lots 1, 2, 4, 7, 8, 10, S2 Section 12: All Section 13: All Section 24: All Lincoln County, Wyoming 2422.33 acres more or less FOR BLM USE ONLY--DO NOT WRITE BELOW Tills LINE THE UNITED STATES OF AMERICA This assignment is approved solely for administrative purposes. Approval does not warrant that either party to this assigmnent holds legal or equitable title to this lease, [ ] Assignment approved for above described lands; Assignment approved effective By [ ] Assignment approved for attached land description [ ] Assignment approved for land description indicated on reverse of this form (Authorized Officer) (Title) (Date) Part A (Continued): ADDITIONAL SPACE for Names and ~ddrcsses of additional assignees in Item No. 1, if needed, or for L~nd Description i~ item No. 2 if needed ACIEdNOWLEDGMENT STATE OF COLORADO COUNTY OF DENVER The foregoing instrument was acknowledged before me this 22'a day of October 2003, by Jose/~rl W. Thames, President of Baseline Minerals, Nota~ Public 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 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 associations 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 District 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 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 (0 Assignee is not in violation of sec. 41 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 (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 assignment is added to all previously created overriding royalties (43 CFR 3241 ). I certify, that the statements made herein by me are tree, complete, and correct to the best of my knowledge and belief and are made in good faith. Executed this 2 22'a /~ October /~ 2003 Or ~ .. losp~, T~mes - PresidenT(SignatUre) Attorney-in-fact / ~ / ~ (Signature) 1645 Cou. Place, Suite 422 (Assignor's Address) Denver, CO 80202 (City) (State) (Zip Code) Executed this da)' of Assignee: C0ndo_/-~xploration, LLC. orAssignee: Attorney-in-fact (s~gaature) Assignee: : :i .; ' Attorney-in-fact 2003 Public reporting burden for this form is estimated to average 30 minutes per response including the lime for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U .S. Department of the Interior, Bureau of Land Management, (Alternate) Bureau Clearance Officer (WO-771), 1849 C Street, N.W., Washington, D.C. 20240, and the Office of Management and Budget, Paperwork Reduction Project (1004-0034), Washington, D.C. 20503 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, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.