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HomeMy WebLinkAbout894808Form 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) FORaM APPROVED OMB NO. 1004-0034 Expires: July 31. 1995 Lease Serial No WYW-156583 Lease Effective Date 1. Assignee* Street City, State, ZIP Code Type or print plainly In Ink and si~ln In ink. PART A: ASSIGNMENT Baseline Minerals, Inc. ,645 Court Place, Suite 422 ~' 54'0 Denver, CO 80202 *If more than one transferee, cheek here [ ] and list the name(s) and address(es) of all additional transferees on the reverse of t~ais form Or on:~ separate attached sheet of paper. 7 This transfer is for: (Check one) [X ] Oil and Gas Lease, or [ ] Geofl~ermal Lease R E C E [ V E D . LINCOLN COUNTY b'LERK lnterest conveyed: (Check one or both, as appropriate) [ ] Record Title. [X]OverridingRoyalty, payment out orproduction or othcr similar interests or payments o-a o n n:3 ntt ,°.8 9:58 2. This assignment conveys the following interest: ~ c, kt r-lh~'ccnt of ~and Description Percent of ln~s~ RI [q E W ~.t~,~ing' Royal. Additional space on reverse, if needed. Do not submit documents or agreements od,er th~ ~is Owned Convey~ [ { [;~, ~ Y ~;]~1~ ~lerests fo~; such documents or agreements shall only be referenced herein. Rescued Previously rescued O~ conveyed A b c d e f to,ship 24 No~, R~ge 114 West 6a P.M 100% 0.50000% 100% Of record Of record Section&Lot l0 ~ ¢~ (0~ Section 17: Lots 7, 8, SWSE ~ ONL~ Sectian 18: Lots 5-8 ~ Section 19: Lots 5-8 Section 29: NW, S2SW, SWSE Section 30: NE Lincoln CounW, Wyoming 866.22 acres more or less FOR BLIH USE ONLY--DO NOT WRITE BELOW TItIS LINE THE 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 app roved effective By [ ] Assignment approved for attached land description [ ] Assignment approved for land description indicated on reverse of tiffs form (Authorized Officer) (Title) (Date) Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, if needed, or for Land Description in item No. 2 if needed 0 4SOS 7 2 ACKNO~VLEDGMENT STATE OF COLORADO COUNTY OF DENVER The foregoing instrument was acknowledged before me this ,~-'j' ?~: day of My Commission Expires: PART B: CERTIFICATION AND REQUEST FOR APPROVAL I. The Assignor certifies as owner of an interest in the above-designated lease that heJshe 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 (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 restrictions pertaining to the lease described herein. For geothermal assignments, an overriding royalty may not be less than on~-fourth (I/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 roy,aRies (43 CFR 3241 ). I certiry,.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 ~ '~ day of , 2003 Name of Assignor as shown on current I ea,~Bt~ d or E;/~: ration, LLC Assignor: Attorney-in-fact V / .?' ' 7720 E~ Belleview Ave~e, Suite B-102 (Assignor's Address) Greenwood Village, CO 80111 (City) (State) (Zip Code) Executed this Assignee: Assignee: or Attorney-in-fact · Assignee: 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. Deparlment of the Interior, B~reau 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.SC. 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.