EX-10.1 6 dex101.htm FORM OF BLM ASSIGNMENT Form of BLM Assignment

EXHIBIT 10.1

 

UNITED STATES

       

FORM APPROVED

DEPARTMENT OF THE INTERIOR

       

OMB NO. 1004-0034

BUREAU OF LAND MANAGEMENT

       

Expires: December 31, 2001

ASSIGNMENT OF RECORD TITLE INTEREST

       

Lease Serial No.:                    

IN A LEASE FOR OIL AND GAS OR

       

Lease Effective Date:             

GEOTHERMAL RESOURCES

       

(anniversary date)

         

New Serial No.                       

 

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)

 

Type or print plainly in ink and sign in ink.

 

PART A: ASSIGNMENT

 

Assignee*

Street

City, State, ZIP Code


* 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 assignment is for: (Check one) ¨ Oil and Gas Lease, or ¨ Geothermal Lease

 

Interest conveyed: (Check on or both, as appropriate) ¨ Record Title,

¨ Overriding Royalty, payment out of production or other similar interests or payments

 

2. This assignment conveys the following interest:

 

Land Description


   Percent of Interest

  

Percent of

Overriding Royalty
Similar Interests


Additional space on reverse, if needed. Do not submit documents or agreements other than this form;
such documents or agreements shall only be referenced herein.
   Owned

   Conveyed

   Retained

   Reserved

   Previously
reserved or
Conveyed


a    b    c    d    e    f

 

 

 


FOR BLM USE ONLY – DO NOT WRITE BELOW THIS LINE

UNITED STATES OF AMERICA

 

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; attached land   ¨ Assignment approved for description

Assignment approved effective                                  description

  ¨ Assignment approved for land indicated on reverse of this form.

 

By

  

 


  
    

(Authorized Officer)

  

(Title)

   (Date)            

 

ADDITIONAL SPACE for Names and addresses of additional assignees in Item No. 1, fi needed, or for Land Description in Item No. 2, if needed.

 

Acknowledgement

 

State of Colorado

County of

 

The foregoing instrument was acknowledged before me by Dennis L. Rosengarten this      day of                     , 2002.

 

Witness my hand and seal

 

 


   

Notary Public

   

My Commission Expires:

 

Part B – CERTIFICATION AND REQUEST FOR APPROVAL

 

1. The Assignor certifies as owner if an interest in the above designated lease that he/she hereby assigns to the above assignee(s) the rights specified above.

 

2.

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 of any State or territory thereof. For the assignment of NPR-A leases, assignee is a citizen, national, or resident alien of the United States or association of such 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 are 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 up to 200,000 acres may be in 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 Mineral Leasing Act of 1920, or 51,200 acres in any one State if this is a geothermal

 

2


 

lease; (d) All parties holding an interest in the assignment 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 (f) Assignee is not in violation of sec. 41 of the Mineral Leasing Act.

 

3. Assignee’s signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions pertaining to the lease described herein.

 

3


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 the rate of royalty due to the 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 in good faith.

 

Executed this      day of                     , 2002             Executed this      day of                     , 2002

 

Name of Assignor as shown on current lease

  

 


    
     (Please type or print)     

 

Assignor

 

 


     Assignee   

 


    (Signature)           (Signature)
   

or

         

or

 

Attorney-in-fact

 

 


    

Attorney-in-fact

  
    (Signature)           (Signature)

 

 


(Assignor’s Address)

 

 


  
  

(City)

  

(State)

  

(Zip Code)

 

Public reporting burden for this form is estimated to average 30 minutes per response including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U.S. Department of the Interior, Bureau of Land Management (1004-0034), Bureau Clearance Officer, (WO-630), Mail Stop 401 LS, 1849 C Street, N.W., Washington, D.C. 20240.

 

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 to any matter within its jurisdiction.

 

(Form 3000-3 (1/99)