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HomeMy WebLinkAbout894806Form 3000-3 (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.) 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 July 31, 1995 Lease Serial No WYW-157434 Lease Effective Date March 1,2003 Type or print plainly In Ink and sign In ink. PART A: ASSIGNMENT 1. Assignee" Baseline Minerals, Inc. Street 1645 Court Place, Suite 422 6 ''~ City, State, ZIP Code Denver, CO 80202 *If more than one transaree, check here I I and list the name(s) and adOress(es) of all additional transarees on the reverse of this f~~rate attached n tofp.p ,. LiN 0LN COUNTY CkEEK This tr~sfer is for: (Che& one) ~ ] Oil ~d Gas Le~e, or [ ] Geothermal Le~e Interest conveyed: (Checkone or both, asappropriate) [ ] Record Title. [X]Ov~i~gO, fiymentoutofproductinnor&~rO0~ simi~ interes~ or paymen~ 2. This asai~nmcnt conwys the followin~ interest: ' Land Description Percent of lnteres[' i, .:~. ~"; [- ;; ;.k; ;. ',;' I ;'~'~r;c;~an~ of Overriding Royalty Additional space on reverse, if needed. Do not submit documents or agreements other than this Owned Conveyed Retained Or Similar interests ~'onn; such documents or agreements shall only be referenced herein. Reserved Previously reserved or conveyed A b c d e f Township 19 North. Range 116 West 6a~ P.M. 100% 0.50000% 100% Of record Of record Section 22: All (ORRI Section 28: NE, S2 ONLY) Section 34: All County, Wyoming ~Z/'~.- Lincoln 1760.00 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 purposek Approval does not warrant that either party to this assignment holds legal or equitable title to this lease. [ ] Assignmenl approved fur 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): ADDITIONAL SPACE for Names and addresses 0f additional assignees in Item No. I, if needed, or for Land Description in item No. 2 if needed ACKINOWLEDGMENT STATE OF COLORADO COUNTY OF DENVER The foregoing instrument was acknowledged before me this 22"d day of october, 2003, by Nixon R. Lange, Manager of Condor Exploration, LL~.2 ,:i. . PART B: CERTIFICATION AND REQUEST FOR APPROVAL I. The Assignor certifies as ovmer of an interest in the above-designated lease that he/she hereby assigns to the above assignee(s) the fights 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, msidant 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 (f) Assignee is not in violation ofsec. 41 of the Mineral Leasing Act. 3. Assignee's signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restxictions 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 certi fy, 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 22ra day of October 2003 Executed this Name of Assignor as shown o~ current lease.." C~ndor ~E~'ploration, LLC Assignee: Attorney-in-fact / rare) - -' 7720 E~t ~ellevie~nue, Suite B-102 : ' (Assignor's Address) -Assignee~ ' Greenwood Village, CO 80111 (City) (State) (Zip Code) Attorney-in-fact 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 (I 004-0034), 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.