Form 3000-3a
(August 2018)
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)
OMB NO. 1004-0034
Expires: June 30, 2021
Lease Serial No.
Type or print plainly in ink and sign in ink.
1. Transferee (Sublessee)* 1a. Transferor
City, State, Zip Code
*If more than one transferee, check here and list the name(s) and address(es) of all additional transferees on page 2 of this form or
on a separate attached sheet of paper.
This transfer is for: (Check one) Oil and Gas Lease, or Geothermal Lease
Interest conveyed: (Check one or both, as appropriate) Operating Rights (sublease) Overriding Royalty, payment out of
production or other similar interests or
2. This transfer (sublease) conveys the following interest:
Land Description Percent of Interest Percent of Overriding
Royalty Similar Interests
Reserved Previously
reserved or
e f
Additional space on page 2, if needed. Do not submit documents
or agreements other than this form, such documents or agreements
shall only be referenced herein.
This transfer is approved solely for administrative purposes. Approval does not warrant that either party to this transfer holds legal or
equitable title to this lease.
Transfer approved effective
Bureau of Land Management (BLM) (Title) (Date)
(Continued on Page 2)
(Form 3000-3a)
Part A (Continued) ADDITIONAL SPACE for Names and addresses of additional transferees in Item No. 1, if needed, or for Land
Descriptions in Item 2, if needed.
1. The transferor certies as owner of an interest in the above designated lease that he/she hereby transfers to the above transferee(s) the
rights specied above.
2. Transferee certies as follows: (a) Transferee 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 transfer of NPR-A leases, trans-
feree is a citizen, national, or resident alien of the United States or associations of such citizens, nationals, resident aliens or private,
public or municipal corporations; (b) Transferee is not considered a minor under the laws of the State in which the lands covered by
this transfer are located; (c) Transferee’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 Minerals Leasing Act of 1920, or 51,200 acres in any one State if this is a geothermal lease; (d) All par-
ties holding an interest in the transfer are otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the autho-
rizing Acts; (e) Transferee 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) Transferee is not in violation of sec. 41 of the Mineral Leasing Act.
3. Transferee’s signature to this assignment constitutes acceptance of all applicable terms, conditions, stipulations and restrictions
pertaining to the lease described herein. Applicable terms and conditions include, but are not limited to, an obligation to conduct all
operations on the leasehold in accordance with the terms and conditions of the lease, to condition all wells for proper abandonment, to
restore the leased lands upon completion of any operations as described in the lease, and to furnish and maintain such bond as may be
required by the lessor pursuant to regulations 43 CFR 3104, 3134, or 3206.
For geothermal transfers, 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 ________________ 20_________ Executed this ___________ day of ________________ 20____
Name of Transferor
(Please type or print)
Transferor Transferee
(Transferors Address)
(City) (State) (Zip Code)
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, ctitious, or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on Page 3)
(Form 3000-3a, Page 2)
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1. Transferor/Transferee(s) must complete Parts A1 and A2
and Part B. All parties to transfer must sign as follows. The
transferor(s) must manually sign 3 original copies and the
transferee(s) must manually sign at least 1 of the 3 original
copies. File three (3) completed copies of this form in the
proper BLM ofce for each transfer of operating rights
(sublease). For a transfer of overriding royalty interest,
payment out of production or other similar interest or payment,
le one (1) manually signed copy of this form. The required
ling fee (nonrefundable) must accompany the transfer,
payment out of production or other similar interests or
payments. File transfer within ninety (90) days after date of
execution of transferor.
2. Separate form must be used for each lease being affected by
this transfer and for each type of interest conveyed.
3. In Item No. 2 of Part A, describe lands affected (See 43 CFR
3106, 3135 or 3241). For columns b, c, d, and e, enter the
interest expressed as a percentage of total interest in the lease,
e.g., if transferor transfers one quarter of a 20% interest, enter
20% in column b, 5% in column c, and 15% in column d.
4. If any payments out of production or similar interest,
arrangements or payments have previously been created out
of the interest being transferred, or if any such payments or
interests are reserved under this transfer include a statement
giving full details as to amount, method of payment, and other
pertinent terms as provided under 43 CFR 3106, 3135, or 3241.
5. The lease account must be in good standing before this transfer
can be approved as provided under 43 CFR 3106 and 3241.
6. Transfer, if approved, takes effect on the rst day of the month
following the date of ling in the proper BLM ofce. If a
bond is necessary it must be furnished prior to approval of the
7. Overriding royalty and payment out of production or other
similar types of transfers must be led with BLM, but will be
accepted for record purpose only. No ofcial approval will be
8. Upon approval of a transfer of operating rights (sublease), the
sublessee is responsible for all lease obligations under the lease
rights transferred to the sublessee.
(Continued on Page 4)
(Form 3000-3a, Page 3)
AUTHORITY: This information is solicited under the authority of 30 U.S.C. 181 et seq.; 30 U.S.C. 1001-1025; 42 U.S.C. 6508
PURPOSE: The primary purpose for collecting this information is to facilitate the timely processing of transfers of operating rights
(subleases) for oil and gas/geothermal resources leases.
ROUTINE USES: This information may be disclosed to agencies, organizations or persons for authorized purposes as follows: (1) The
approval of transferee’s rights to the land or resources. (2) Documentation for public information in support of notations made on land
status, records for the management, disposal, and use of public lands and resources. (3) Transfer to appropriate Federal agencies when
concurrence is required prior to granting a right in public lands or resources. (4) Information from the record and/or the record will
be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or
prosecutions. Additional information on authorized routine uses may be found in the published system of records notice, BLM-3, Mineral
Lease Management—Interior, which may be viewed at
DISCLOSURE: Furnishing the information on this form is voluntary, however, failure to provide all or part of the requested information
may result in the rejection of the transfer. See regulation at 43 CFR Groups 3100 and 3200.
The Paperwork Reduction Act of 1995 requires us to inform you that:
The BLM collects this information to create and maintain a record of oil and gas/geothermal lease activity.
Response to this request if required to obtain benet.
The BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored information collection
unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: 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
Information Collection Clearance Ofcer (WO-630), 1849 C Street, N.W., Room 2134LM, Washington, D. C. 20240.
(Form 3000-3a, Page 4)