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(Jaau,~ 1996)
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 I..~,.~t. sing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Land~ of 1947 (30 U.S.C. 351-359)
Geothermal Stem:n Act of 1970 (30 U.S.C. 1001-1025)
D~paru~ent_of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)
Type Or print plainly In Ink and si~/n In Ink.
FORM APPROVED
OMB NO. 1004-0034
Expires: September 30. 1998
Serial No.
~YW- 1 22223
Lease Effective Date
(Anniversary Date)
November 1 ,
1990
New Serial No.
c~, s~., ~ c~ ¢¢~¢~¢ LINOOL~J COUNTY O~
T~ r~ord fide ~sig~ent is for: (Check one) ~ OH ~d G. ~.e, or a Geome~ ~e JEANb E WAGNER
~terest conveyS: (Check one or both, ~ approp~ate) ~ R~ord Tide, ~ OveMding Roy~, pa'yin:eEl ofi-i'~'f ¢~fi~%r o~er s~il~
~resu or paymeau
2. This assil[gnment conveys the foIJowin~ interest: ORRI
· Land DeScription Percent of Interest Percent of
Additional space on reverse, il' needed. Do not submit documents or agreements olher fi'mn Owned Conveyed Retai~ed Overriding ROyalty
this form; such documents or agreemena shall only be referenced herein, or Sirrfilar Interests
' Re,~rved Previously
or cOn¥cyed
a b c d e f
Pownship 23 North, Range 112 West,. 6th P.M. 1.5% 1.5% -0-
of o£
~ection 11: P../2, SW/4 8/Sth~, 8/Sth~
r.±neoln County, Wyom±ncj
:onta±nincj 480 acres more or less
FOR BLM USE ONLY--DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AJvlTc_R~CA
This a~stgnmeat is approved solely for achnlnNtr~ative purposes, Approval do~ act warrant that either part)' to this assignment holds legal or
~uit~ble tide to thb lease,
[] Assignment approved for above described lands; [] Assignment approved for attached land description
Assignment approved effective
[] Assign. ment~ approved for la.nd description indicated on reverse
of this form.
(Authorized OfficcO Vl'idel rl'~:;,~ ~
mcat
Pan A (Continued):
See
ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, if needed, or for Land Description in llem No. 2, if
needed.
A'ckaehed "Exhib±k A"
340
08 4 54
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
1. 'rhe Assignor cerlifies as owner ~f a~ inlcrest in Iht above deMgnalcd lease Ihal he/she hereby assigns Io lhe above ass;ghee(s) Ihe rlghls specified :~hove.
2 A.'.signee cerl/fies as I'ollows: {:~) Assignee is a ch;zen of Ihe Un[ted Stales; an associalion of such c[tlzens; a mun[clpallly; or a corporallon organized ~nder
laws of the Untied States or of any Slate or tcrrilory Ihercof. For Ibc asMgnment of NPR-A leases, a~lgnee is a citizen, nalional, or residenl alieu or the United
Stales or associslion of such cilizens, nationals, resident aliens or privale, public or municipal corporations, (b) Assignee is nol con.aidered a mlaor adder the
laws of the SOle in wh ch Ibc lands covered by.this assignment are located; (c) Assignec's chargeable ir. lcrests, direcl and indirect, in each public domain and
acquired lands separately in Ihe same Slate, do not exceed 2,t6,080 acres in oil and gas leases (o{ whi!:h up to :200,000 acres may be [n oil and gas op6ons), or
.a00.000 acres in leases in ench leasing Districl. in AlS.aka of which up to 200,000 acres m~y be In options. [f Ihls is an oll and 8as le~se Issued Iv accordance
wilh Ihe Mineral L~asing Act o1' 1920, or 51,200 acres in any one Slale ~[' Ibis is a geolhermal lease; (d) All parties holding ~n interest in the assignra¢~t
otherwise in compliance w~ih'the regulations (43 CFR Group 3100 or 3200) and the suthorlzing Ace.a; (e) Assignee i.a in compliance with
requi'rements for all Federal oil and gas lease holdings as rcqulred by sec, 17(g)of the Mineral L, enslng Act; and (0 A.,;slgnee is not In violalloa of sec. ~1 of
MinerM L~aslng Acl.
Assignce's sign.alure to th~s assignment constitules acceptance of al! .,~ppllcable lerms, conditions, sl[pulallons and rcstrlclions pertaining to Ihe lease destrib,.'~l
herein.
For ffeolhermal assignments, an overrldlng royalty rnny nol bt less than one-I'ou.h (1/4) of one percent o{ Ihe vHue of oulpul, our greater than $0 perc_enl o1' t§e rate
royally due lo the United Stales when Ibis asslg, nmenl is ~dded to all .previously'created ove!'Hding royallies.O.13.CER 32.11).
I ceftin, that thc statements made herein by me arc true, complete, and correct to thc best of my knowledge and belief and arc made in go~d faith.
Executed this 1 St day of October ,' · ~.O0..q Executed tiffs day of
Name of As-signor as shown on curr~t lease W±nc].sor ~.xp].orak [nc~
A.omey-in-r.c~ ~ ..... Attorney-in-act
(Signature) (Signature)
475 qTth Street, ate. 600
(Assignor's Address)
Denver, Colorado 80202
(City) (State) fZia C~e)
19
Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing i~s~u'u[ttons, gathering and maintaining data. and
completing amf reviewing the rorm Direct comments regardin£ the burden estimate or ,'my other aspect of this form to .o. ue~arnnent of the Interior. Bm-eau of L,'md
Management, Buma. Cle~,'mce Officer (DW-I I0). Denver Fec]eral Center. Building 40, P.O. Box 2.5047, Denver. CO 80225-0D47 and the Office of Management and
Budget. Paperwork Reduction Project (1004-0034). WashinDon. D.C. 20503.
Title 18 U.S.C. Sec. IOOI makes it a crime for any person knowingly and willfully to make to any Department or agency of Ihe United States any raise, fictitious or fraudulent
stalcmci"iks or feprdls, .] i, to any mailer within its jurisdiction. "'""';'""
CORPORATE ACKNOWLEDGMENT
STATE OF
CITY & STATE OF
On this /~J~ day of
)
) ss
)
,2003, before me personally appeared
and that the seal affixed to said instrument is the corporate seal of said Corporation and that said instrument
was signed and sealed in behalf of said Corporation by authority of its Board of Directors, and said
/o~.fz/gPTd ~/~7~a:~f~/'fi' acknowledged said instrument to be the free act and
deed of said Corporation.
Wimess my hand and seal this / ~ ~-~--rlay of t~~~ ,2003.
My Commission Expires: _~- ~ ~ '- 0 ~
Notary Public
Address:
342
EXHIBIT "A"
Attached to and ~nade a part thereof that certain Assignment of Overrid lng
Royalty between Windsor Exploration, Inc as Assignor and the parties listed below as
Assignees as to the percentages shown.
Name and Address Percentage of ORR[ Assigned
Shawn P. Hannifin and
Frances A. Hannifin as
Joint Tenants with right
Of Survivorship
P.O. Box 8687
Denver, Colorado 80201-8687
9.2584%
Alan R. Hannifin - A single Man
P.O. Box 8687
Denver, Colorado 80201-8687
9.2584%
Fall River Resources, Inc.
P.O. Box 13456
Denver, Colorado 80201-3456
9.2585%
Maureen S. Schultz
934 South Fillmore Way
Denver, Colorado 80209
27.7780%
Edward N. Agurkis, Jr.
475 17th Street, Suite 600
Denver, Colorado 80202
44.4467%