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Home My WebLink About895907-'~onn ~0oo4 (Janaary ~,996) ~ ~ 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 FQRM APPROVED OMB NO. 1004-0034 Expires: September 30, 1998 Lease Serial No. WYW-1 56578 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) Lease Effective Date (Anniversary Date) November 1, 2003 New Serial No. Type or print plainly in ink and sign in ink. PART A: ASSIGNMENT I' Assignee* EOG Resources, Inc. ~2)O~R Street P.O. Box 4362 City, State, ZIP Code Houston, TX 77210-4362 *If more than one assignee check here [-~ and list the name(s) m~d address(es) of all additional assignees on the reverse of this form or on a separate attached sheet of paper. This record title assignment is for: (Check one) [-~ Oil and Gas Lease, or ~ Geofl~ennal Lease Interest conveyed: (Check one or both, as appropriate) ~ Record Title, ~ Overriding Royalty, payment out o£production or other similar interes, ts or payments This assigmnent conveys fl~e following interest: · Land Description Percent oflnterest Percent of Additional space on reverse, if needed. Do not submit docmnents or agi-eements other than Owned Conveyed Retained Overriding Royalty this fo.nn; such docnments or agreements shall only be referenced herein. ' or Similar Interests Reserved Previously reserved or conveyed A b c d e f TOWNSHIP 22 NORTH, RANGE 112 WEST, 6mPM 100% 100% -0- -0-. -0- Section 15: W2NW Containing 80.00 acres, more or less, in Lincoln County, Wyoming : ktO · vI -~q CO FOR BLM USE ONLY - DO NOT WRITE BELOW THIS LINE .~ ;'~rl : UNITED STATES OF AMERICA -,- ~ ,- rtl _,~, , C,.rI ~..) ~ This assignment is approved solely for administrative purposes. Approval doe~ not warrant that either party to thb as~i~.~ment holds I{g~ equitable title to this lease .... - -.~:L' ~ 2 < ~ Assignment approved for above described lin, ds; , ,~ *,sig,,,nent approved rot attached;i';tCd'desc;;ion -< ~ Assignment approved effective ~ Assignment approved Dr l~d de~ipt~n i%djcated ~ reverse of this form. ~ By (Authorized Officer) (Title) (Date) Part A (conth~ued): 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. STATE OF COLORADO COUNTY OF DENVER BEFORE :.-ME,Ahe undersigned attthority a Notary Public on this da personally appeared Gary Butler, to me known to be the ,dent,cal~ i~---'~d the name of the maker thereof to the foregoing instrument as its President and acknowledged to me that he exec~'~ ~, ~ . .;~~., and voluntaW act and deed and ~ thc free and volunta, act and deed of'such corPoration, for the uses ~n(~:m 'h~d~:~office, thisthe ~ dayof ~ MY 't~h~n Expires2 Jal~4' 2005~ ~'::*~~ Nota. Public:~ Elly Barnes ~ Address:· ~ 11412 West Prentice Dr ~ ~mm~ ~ 01~ Littleton, CO 80127 k PART B: CERTIFICATION AND REQUEST FOR APPROVAL Tile Assignor certifies as owner of an interest in the above designated lease that he/she hereby assigns to the above assignee(s) tile rights specified above. 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 any State or territory thereof. For the assignment of NPR-A leases, assignee is a citizen, national, or resideut alien of the United Stales or association of sucb 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 m'e 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 200,000 acres may be itl 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 Miueral 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 assignnmnt 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. Assignee's signature to this assignmeqt constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to tile 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 tile rate of royalty due to tbe 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 true, complete, and correct to the best of my knowledge and belief and are made ill good faith. xecnted fills ~ day of .~1/~___~-~ ,20 D ~' Name of Assignor as shown on ~ 17asc/~ntex Energy (5o~nDan¥ (S,j/g~ture) dGdry Butler, President or Attorney-in-fact (Signalure) 1645 Court Place, Suite 212 (Assignor's Address) Denvert CO 80202 (City) (State) (Zip Code) Executed this day of,D~,,,~/'-"~ EOG Resources, Inc. Assignee or (Sign~. Attomey-in-fa[t (Signalure) R. L. ADAMS AGENT AND ATI'ORNEY-IN-FAC~ Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing instructions, gatherh~g and ma n dining data, and completing and reviewing the form. Direct'cmnments regarding tile burden estimate or any offler aspect of fffis form to U.S. Depamnent of file haler]or, Bnreau of Lined Management, Bureau Clearance Officer (DW-110), Denver Federal Center, Building 40, P.O. Box 25047, Denver, CO 80225-0047 and the Office of Ma lagement 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 lo any matter within its jurisdiction. *U.S. GPO: 1996-774-004/41005