HomeMy WebLinkAbout895053Form 3000-3
(Janunry 1996)
DEPART~iENT~OF~ THE INI'~ERIQR
BUREAU OF L Mtd MAHAGd'~EHt
03 AUG 22 AH 9'. O0
UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
FORM 'APPROVED
o~m No. ioo~oo34
ASSIGNMENT OF RECORD TITLE INTER:E~T~,I~N A
.... [~" . LEASE FOR OIL AND GAS OR GEOTHERMALri~ESO~R~ES
~H~YEN'qE, WYOHING . Min~r~ ~g Act of 1920 (30 U.S.C. 181 eCseq.) (An~versa~?~
Act for Acqu~ ~ds of 1947 (30 U.S.C. 351-359)
Geo~em~ Stem Act of 197~0 U S C 1~!-i025)
' . "/ ....... ' ~:' " ! , .
Type or print plainly In Ink and sign In Ink. .. '
PART A: ASSIGNMENT
Assigne~* shawn P. Hanni fin ..,;..),~NCOLN .?~(., ~...-, CLERK,:'
more ~ oa¢ ~sign~, ch~k here ~ and list ~e name ~
ms r~ord rifle ~sigment is for: (Check one) ~ Oil ~d Gas ~e, or ~ Geo*cnm
~lercst conveyS: (Check one or both e~ ~pprop~ate) ~ R~ord Title. ~ Ove~iding Roy~. paymenl out Of pr~uc6on or oflmr si~
'~ 'inlere~u' or payments
Additional space on r~vers~, if neaxl~l. Do not subntil docum{nLr, or ~g~eemenLs olher than O~;ned 'Conveyed Retained Overriding Royally
Ih~s form. such documenLs or agr~ments shall only.j~ rcfer, enc. ed.hcr{m ........ i ..... r~ ./._.. 'i' /. ........... or Similar Interests
Reserved Previously
or conveyed
a b c d e f
Township 23 North, Range 112 West, 6thP.M 100% 100%. None 5.0;~ None
Section 10 NE, NENW of
8/Sths
Lincoln County, Wyoming
containing 200 acres, more or less
Subject 'to the attached rider which includ s
a reassignment rider.
. :. .,... , ........ FOB ,BLM USE ONLY--DO NOT,RITE BELOW TH S LINE · ' ~.~.~=,.~. '
............... 7' ............. =' U .......... UNrrED STATI~ OF AMEmCA .... "FOR ASSISNk~:,
,,. ,, ~,.~. , ;.,~; ..,. ;,~ ~.' ~ . . ~ ~'~
~lgnment h approved,Solely,',fom';'ad~trativepur~cs; ApproV~ d~ not'w~rant that eiiher party to thh ~si, i~nl h~l~ I ~ or
. . -~ ~
title to ~h I~e;
sigmcnt approv~ for a~ve dcscri~ I~ds; , ,..
Assignment approved effcctivc SEPO
/$/i:.:T- :7; G'OOKIN
By ~::.: ::~:i
l 2003
.[-1 As'signment approved fo,' attached land description
[] Assignment approved for land description indicated on reverse
of ti,is form.
.... · ',~'.,,,,;~, ID LAW EXAMINER _ _
Part A (Continued):needed.ADDITIONAL SPACE for Names and addresses of additional assignees in hem No. 1. if needed, or for Land Description in Item No. 2, if
The overriding royalty reserved hereunder shall be calculated and paid on at least as favorable a basis as royalty paid to fl~e United States on
federal oil and gas leases, and in no eveflt shall fl]ere be any deduction for any expense incurred in making file oil, gas and other products
marketable or ready for use, including, bdt::]ipi'iiii~?,d'td'~l~W~t~iing'' carbon: ,di°xide~ ;~rem°val' dehyckatiou.· separating, storing, compression,
gathering and transportation costs. ' .....' ......:: ':. : -
_.REASSIGNMENT RIDER ~ ; .... .. . .,. . ~
h! ihe event Assiguee desires to relinquish the herein described lease as to all or any part of the acreage covered thereby, Assignee shall
notify Assignor sixty (60) days prior to the next accruing rental date under said oil and gas lease of Assignee's desire to relinquish said oil
and gas lease. Assignor shall then have the right for a period of rd'teen (15) days after tile receipt of such notification in which to request to
Assignee that said oil and gas lease be reassigned to Assignor, and Assignee shall then execute an assignment of said oil and gas lease to
Assignor. However, Assignee shall not be liable, in dmnages or otherwise, for failure to give such notice due to clerical ~rror, mistake or
oversight except liability not to exceed the amount flint was paid for tiffs Assignment. Clerical error shall include, but not be lmfited to,
reinstatement of a federal oil dud gas lease pursuant to tixe Code at' Federal Regulations, Title 43, Subsection 3108.2-2. Any reassigmnent
under tixe terms of this paragraph shall be free and clear of all burdens, encmnbrances, or outstanding interests other than those existing on the
date here0.f and Assignee or Assiguee's assigns agree not to create any reassigmnent obligations on the herein described lease superior to ti]is
reassigmnent obligation.
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
The Assignor cerlifies as owner .~f a '~ inlcresl in the above deslgnaled lease Ihal he/she hereby assigns Io thc above assignee(s) Iht rights specified above.
STATE OF'COLORADO )
COUNTY OF DENVER )
On the 29th day of July,2003, personally appeared before me Joe Freeman, Partner, Free
who duly acknowledged to me that he executed the same.
Given under my hand and seal this 29th day of JUly, 2003. ,
My Commission Expires: ,
March 9, 2005
tbove instrument,
....... '~T""7 ""~ '~ ,,,~ ~,,,.=u ~,,.,~.-. ~,,c. r.,.~ a~gr~mcnt is auueu lo all previously crealCd overrldillg r0yallie.~ (4.t L-PR 3241)2
I certify that the slatements made herein by me are true. complete, and correct to thc best of my knowledge a.nd belief and are made in good faith.
Executed this 2 9 1: h day of aU ] y ,19 2 0 0 3 Executed this t~_~,m ~ day of
Name of Assignor/d~show~t)~Cu. rrent lease Fre e._~_m_a n I n v e s tree n t S
type or
Assi.nOror ~//~'~(Signature' - A'~ignee S h aC.~Or "' ' ~/ ',,nature)
nh if in
Attorney i t
Anorney-in-fact
(Sig.a re)
3415 S. Clay1:on Blvd. ,,
(Assignur's Address)
Englewo0d, Colorado 8011.~-7611
(City) (State) (Zio Code)
· Public reporting burden for Ihis 'arm is esdmaled to average 30 minutes per response including the time for review n nstrucfions athe '
completing and-review n, the form DiJ'e t ' · ' . ' . g . , g rm and m,3i. 'nminin dais, and
.... g . c comments regurdmg the burden esnmate or any other aspect of th~s form to U.S. De amnent of t~e Interior, Bur~u of Land
Management. Bureau uearance or'ricer eDW-110) Denver Fe(leral Center Building 40 PO Box 25047 Denver CO 802'35-~:~47 and the nffi,-,, ,-,~ ~ ....... o ,~,~
Budget. Paperwork Reduction Project (1004-0034), ~,/ashington, D.C. 20-503.' ' ' ' ' ' ~ ~ .......... e ..........
Title 18 U.S.C. Sec. i001 makes il a crime for any person knowingly and'willfully to make lo any Department or agency of the United Slates anv_r, ~. n¢,itious
'statements' or represj. ;: ~ to any mfillcr within ils jurisdiction, t ::]:i(ii;)?'ii; - or fraudulent