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.
PART B – CERTIFICATION AND REQUEST FOR APPROVAL
1. The transferor certies as owner of an interest in the above designated lease that he/she hereby transfers to the above transferee(s) the
rights specied above.
2. Transferee certies 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
(Signature)
(Signature)
(Title)
(Title)
or
Attorney-in-fact
or
Attorney-in-fact
(Signature)
(Signature)
(Transferor’s 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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