HomeMy WebLinkAbout899870Form 3000-3
(January 199q) '
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.)
Ac: for Acquired Lands of 1947 (30 U.S.C. 351-359)
Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
Depam~ent of the Interior Appropriatioas Act. Fiscal Year 1981 (42 U.S.C. 6508)
Type or print' pl, alnly In Ink and sign In Ink.
FORM APPROVED
OMB NO. 1004-0034
Expires: December 31. 2001
Lease Serial No.
Lease Effective Date
(Anniversary Date)
New Serial No.
PART A: ASSIGNMENT
Assignee* James Patrick Doer~ingsfeld
Stn~t PO Box 2231
City, State, zn, Code Concord, New Hampshire 03302
*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 title assigmnent is for: (Check onel [] Oki and Gas Lease, or [] Geothermal Lease
Interest conveyed: (Check one or both, e.s appropriate) [] Record Title, ~ Overriding Royalty, payment out of production or other similar
interests or payments
2. This assi[~mnent conveys the followin$ inteie.~t:
" Land DeScription Percent of Interest Percent of
&ddifional space 9n reverse, if needed. Do not submit documents or agreements other than Owned Conveyed Retained Overriding Royalty
bis form; such documents or ag~:m~nts shall only b~ referenced herein, or Similar 'interests
Re.served lheviou~ly
or conveyed
a b c d e f
Please see attached Exhibit A. Unknox~ 100% 0% None None
REC IVI:_ D
' LINCOLN Cc ur'.,JT'f CL ERK
FOR BLM USE ONLY--DO N~'I:'~h'I'TE BELOW'THIS LINE
UNrr~D ST^TES OF AIdERIC^
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 approved for attached land description
Assignment approved effective
ti:;::'
By
[] Assignment approved for land description indicated on reverse
of this form.
· . ~.'w,', ~;5, ...... -:-:-~'-
Part A (Continued):
ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. I if needed, or for Land Description in Item No. 2, if
n~eded. '
817
PART E;: CERTIFICATION AND REQUEST FOR APPROVAL
'l'he Assignor Ce{lilies as owncr ~f a'~ intcrc:;I ir Ihe above designaled lease Ihal he/she hereby assigns ,o Ihe above assignee(s) Ibc rights specified above.
2, Assignee certifies as follows: (a) Assignee isa citizenoflhe UnhcdStates; an associalionofsuch ci,izens; a municipality; or a corporation organized under the
laws of the Untied Slates or of any Slate or territory Ihereof. For ,he assigflmen, of NPR-A leases, assignee is a cilizeu, national, or residenl alien of Ibc United
States or association of such citizens, nationals resident aliens or private, public or municipal co~poralions, (b) Assignee ts no, considered a minor under
laws of Ihe Stale in which the lands covered by Ibis assignment are located; (c) Assignee's chargeable inlcresls, direct and indirccl, ia each public domain and
acquired lands separately in Ibc same Slain, c]o not exceed 246,080 acres ia 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 Dislricl in Alaska of which up to 200,000 acres may be ia options, if this is an oil and gas lease issued in accordance
wilh thc Mineral Leasing Act of 1920, or 51,200 acres in any one Slalc if this is a geolhermal lease; (d) All parties holding aa init{es! in thc assignment are
otherwise ia compliance wilh ~he regulations (43 CFR Group 3100 or 3200) and Ihc authorizing Acls; '(e) Assignee is in compliance Wilh reclamalion
requi'rcmenls for all Federal oil and gas lease hol.:lin'gs as required by sec. 17(g) of thc Mineral Leasing Act; and (ir) Assignee is not in violalion of sec. 41 of
Mineral Leasing Acl.
3. Assignee's signature to this assignment con~.tilutes acceptance Of aH applicable terms, conditions stipulations and roil{actions po{loaning to the lease described
herein. '
· For geolhermal assignments, an overriding royalty :'no) not be less than one-fo'urlh (1/4) of one percenl of the value of oulpul, nor greater Ihan 50 percent of Ihe rate al
roya!ly duc in the United States when this assignment is added io all previously crealed overriding royalti'es (43 CFR 3241).
I certify that thc statements made herein by mc arc :rue, complete, and correct to thc best of my knowledge and belief and are made in good faith.
Executed this day of " , 19 Execuled this day of ___ .Z '
' Janes Patrick feld, Successor Tr{[§-tee o-f-'6~e
Doerings '
Name of Assignor Bs shown on~as~Wa$t-'er, W ..... Doer~ngsfeld TrustTeeme~.~ed~ 4a1~.88
or ~ignature)/~'--
Attorney-in-fact Attorm:y.in ~.la~ct .
(Signature) (Signature)
PO Box 22~1
(Assignor's Address)
Concord, New Hampshire 0330'2
(City) (Stat~) (Zi~ Cod,q
Public reporting burden for Ihis form is estima£ed to aveiage 30 minutes per respa ~se including the time for reviewing nstructions gathering and mainlaining data, and
completing aqd reviewing the form. Direct comrnenta regarding lbo burden eslimate or any other aspect of this 'on't to U.S. De~m'tmem of the Interior, Bureau of Land
Ma,,agement (1004-0034). Bureau Clearance Officer (WO-630) Ma I Stop 401 LS 849 C St{eel N W Was lingtol D C 90.40 '
Title I 8.U.S.:.~'~. Sec. 1001 makes it a crime for any person 'knowingly and willfully lo make to any Department or agency of the United States any fal~, fictitious or fraudulent
slatements or"i'epfesentations as to any mailer within ifs ]m'isdiction.
?
STATE OF
!
:SS.
COUNTY OF
'4
The foregoing instrument was aclmowledged before me by James Patrick
,this /~- day of Y3d~ ,2004.
Witness my hand and official seal.
Nota~ Publi~/ ~'[ ~
My commissionexp n es.~y' ........... uu,,,,,,,oo,~,, ~.~.~ .... ~,,nJ~l. ~, 2~ -~,
Exhibit A
uinta County, Wyominl~
Federal Oil and Gas Lease Serial Number: W-82345, possibly -known as W-94683
T 1.2N,
Section 10:
Section 11:
Section 12:
Section 13:
Section 14:
Section 23:
Section 24:
R 114 W, 6th P.M.
Lots 1, 2, 7, 8, S½NE¼, NW¼, N½SW¼, NW¼SE¼
Lots 1, 2, 3, 4, 5, 6, 7, 8, NW¼NE¼, S½NE¼, N½SE¼
Lots 1, 2, 3, 4, 5, 6, 7, 8, S½N½, N½S½
All
All
NE¼, N½NW¼
N½NW~A, SW¼NW¼
T 13 N, R 113 W, 61h P.M.
Section 16: All
Lincoln Connty, Wyoming
County Line Federal Number 22-6
Federal Lease Number WYW 67176
T26 N, R Ill W, 6th P.M.
Section 6: SW¼NW¼
County Line Federal Nttmber 24-6
Federal Lease Nmnber WYW 59774
T26 N,R 111 W, 6th P.M.
Section 6: Lots ii, 7, E½SW¼
Hanson Fed 40-6
Federal Lease Number WYW 72845 or W-67176
-T 26 N, R 111 W, 6th P.M.
Section 6: Lots 3, 4, 5, 6, 7, SW¼NE¼, SE¼NW¼, W½SE¼
NE¼SE;/~
Section 7:
Carbon County, Wyominl~
Federal Lease Numbers WYW-4 l 314, WYW-48086, WYW~32360, WYW-26084,
and WYW-38012
T 14 N,.R 92 W, 6th P.M.
Section 10: SE¼N!'E~/;, NE¼NW¼
Section 11: NW¼ SW¼, SW¼NE¼, NW¼SE¼
Section 14: SE¼SW¼, NW¼NE¼
11119