HomeMy WebLinkAbout897775Form 300Q, 3
(Janua-y 1996)
· I. JNITED STATES
~SIG.N~ENT OF RECORDs~ITLEH~TERES~I~
. L~F~I.L AND GAS OR G~HERMAL'REsooRcEs
M~Cr~ L~g Act of 1~0
Act for Acqu~ed ~ds of 1947 (30 U.5.C. 35t-359)
~o~c~ S~ Act of 1970 (30 U.&C. l~l-I~5)
~pa~ent of ~e ~tcHor AppropHado~ Act, Fisc~ Y~ 1981 (42 U.S.C. 6508)
0 R]"~ %-!:' ;~:~kV E N CREEK
ORRZ ~ ':!(:!2LOW CREEK
ORRI CHURCH BUTTES
FORM APPROVED
OMB NO. 1004-0034
Expire,s: September 30. 1998
Lease Serial No.
Exhibit "A"
Lease Effective Da~
(Anniversary Date)
New Serial No.
Type or print plainly In Ink and slain In Ink.
PART A: ASSIGNMENT
Assignee* K:trkwood Oil & Gas LLC 5'~9 '
S~eet P.O. Box 3439 BOOK
Cji/, Sm~, ZIP Code Casper, WY 82602
*If more than one assignee, check here [] and list the name(s) and address(es) of all additional assignees on the reverse of this form or on a
separate attached sheet of paper.
This record ddt assignment is for: (Check one) [] Oil and Gas Lease, or [] Geothermal Lease
Interest conveyed: (Check one or both, c.z appropriate) [] Record Tide, ~R~xOverriding Royalty, payment out of production or other similar
interests or payments
2. This assignment conveys the fotlowin~ interest:
Land Description Percent of Interest [ Percent of
Additional space on reverse, if nth:(:led. Do not submit document~ or agreements other than Owned Conveyed RetainedI Overriding Royalp/
or Similar Interests
this form; such documents or agreements shall otfly be referenced herein.
Reserved Previously
or conveyed
a b c d · f
Mass Transfer: See attached Exhibit "A" various 100% -0- -0- Of record
for description of leases and lands. The
overriding royalty ~nterest assigned
applies to each of the described leases.
It Js the ~ntent of th~s assignment to
transfer all of William C. K~rkwood aka
W. C. K~rkwood's overriding royalty ~ntere t
FOR BLM USE ONLY--DO NOT WRITE BELOW THIS LINE
UNITED STA%Tr~ OF AJ~ERICA
This assignment is approved solely for achnini~trative purposes. Approval does not warrant that either party to this assignment holds legal or
equitable title to this lease.
[] Assigmnent approved for above described lands; [] Assignment approved for attached land descripuon
Assignment approved effective
[] Assignment approved for land description indicated on reverse
of this form.
By
('Authorized Officer)
(Tide) (Date)
~ ' "i<'.: ;;?;, '
-': ;: . '.: .<:<":':-':":" - ' .i"::,i,:
Pan 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.
STATE OF WYOM1NG )
) ss
COUNTY OF NATRONA)
The foregoing instrument was acknowledged before me by William C. Kirkwood this 28th day of
January, 2003.
Witness my hand and seal.
Notary Public
PART B: CERTIFICATION AND REQUEST FOR APPROVAL
1. Thc Assignor cerlifics as owner ff a'~ interest in Ibc above designated lease thai he/she hcrcby assigns to Ihe above assignee(s) Ihe rights specified above.
2 Assignee Certifies as follows: tn) Assignee isa cilizen of the Uniled States; an association of such citszcns a municipality; ora corporation organized under the
laws of the United States or of any Slate or lerrilorv thereof. For ibc assignmcnl of NPR-A lasses, assignee is a cilizen, nalional, or resident alien of the Untied
Slates or association of suc}~ ctlizcns, nationals, resident aliens or privale, public or municipal corporalions, (b) Assignee is nol considered a minor under the
laws oflheStale in which the lands covered by this assignmenlare located; (c) Assignee's chargeable inleresls direct and indirect, in each public domain and
acquired lands separately in the same Stale, do not exceed 246,0S0 acres in oil and gas leases (o['whk:h up Io 200,000 acres ma)' be in oil and gas options), or
300,000 acres in leases in each leasing District in Alaska of which up lo 200,000 acres may be in oplions, 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 Slain if Ibis is a geolhermal lease; (d) All parlies holding an inlerest ia the assignmenl are
otherwise in compliance with Ihe regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Assignee is in compliance with reclamation
requi'rcments for all Federal oil and gas lease holdings as reqnJredby sec. l'7(g) of the Mineral Leasing Act; and (ir) Assignee is nol in violation of sec. 41 of thc
IVlineral Leasing Act.
3. Assignee's signature to this assignment constitutes acceplance of al~ applicable lerms, conditions, slipulalions and rcslricHons perta'ining Io the lease described
herein.
For geothermal assignmenls, an overriding royally may not be less Ihan one-fourth (i/4) of one percent of the value of outpul, nor grcaler than 50 percenl of Ibc rain of
royally due to the Untied Slales when Ibis assignment is added Io all previou:sl.,,' created overriding royalties (43 CFR 3211).
I certify that the sthtcmcnts made herein by me are true. complete, and correct to thc best of my 'knowledge and belief and are made in good faith.
' ' 2003 28tfi January
Executed this 28th day of January, 19 Executed this .,day of
Wllilam C. K~rkwood aka ~" ; '
Name of Assignor as Show?.on current lease W C . ~ Kan rkwo/od ~'~K~ rkwood Oj'l.~ & Gas.~LC
' ... · ' ' ' - ~" r'nt ,
or (Signature)
Anorney-in- fact
(Signature)
P. 0. Box 3/439
(Assignor's Address)
Casper, WY 82602
(City) (State)
(Zio Code)
., 003
(Signature)
or Wanllanam C. Kanrkwood, Hanager
Attorney-in-fact
(Signature)
Public reporting burden for thLs form kg estimated to average 30 minutes per response including the time for reviewing insu'ucfions atherin and mainminin d
completing and'reviewing the form Dire~t commenL~ re ardino the burden e" ' ' ' "g . g ara. and
Manmeement n ...... ct ....... .--.7 .......... g - ~ , ~ sir.mate or any other a. qpect of this form to U.S. Department of t~ Interior, Bureau of Land
. _o .:. ....... ,,~.o .,7,~, ,mc..c ~tncer {l)w-i Iv). Denver r'eoeral t~enter, Building 40 P,O. Box 25047, Denver. CO 80225-0047 and the Office of Managemenl and
~uaget. ~aperwor< iqeouctlon ~'roject 11004-0034). Washington, D.C. 20503.
Title 18 U.~'.C. Sec. 1001 makes il a crime for an.',' person knowingly and willfully tu make lo any Department or agenc~ of the United States any false, fictitious or fraudulent
sta,ements or representations as to an>' ma.er withf~.T'~'~..isdic~! ion ~!15}i:~!7~
"a '~ "::-' ~:.:'
,DATE: 01/16/03
PROSPECT: CHURCH BUTTES
COUNTY: LINCOLN, WY
STATE: WY
LEASE STATUS: OR
LEASE NO LESSOR
Exh i bi t ' A~ - Lease Schedu [ e
LESSEE/LEGAL DESCRIPTION
~EASE DT GR-ACRES BOOK PAGE
00096800 W-O261433-A
SARAH IDEEN
T19N R113W Sec.12
24
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SN, NNSE, S/2SE
ALL
11/01/63 1040.00
00096900 ~-026'1238
FRED P. BLUME
T19N R112g Sec.8 S/2
11/01/63 320.00
00881100 ~-90210
SARAH IDEEN
T19N Rl13~ Sec.12
NE, NEN~,
NESE
11/01/63 240.00