U. S. Department of the Interior OMB Control Number: 1010-0006
Minerals Management Service OMB Approval Expires: xx/xx/xxxx
Lease No.
ASSIGNMENT OF RECORD TITLE INTEREST IN
New Lease No. (MMS Use Only)
Legal description of land/area being assigned:
Assignor(s) does hereby sell, assign, transfer and convey unto Assignee(s) the following undivided right, title and interest:
Insert name and Company number of each Assignor and Assignee.
Assignor(s): Percentage Interest Conveyed
Assignee(s): Percentage Interest Received
The approval of this assignment is restricted to record title interest only.
Exhibit “A,” which sets forth other provisions between Assignor(s) and Assignee(s), is attached to and made a part of this assignment.
This Assignment of Record Title Interest has been filed as of the date stamped on this document and hereby approved by the Minerals Management Service on the date below.
By__________________________________ ______________________________________________
Authorized Official for MMS Title Approval Date
Paperwork Reduction Act of 1995 (PRA) Statement: The PRA (44 U.S.C. 3501 et seq.) requires us to inform you that we collect this information to use in the adjudication process involved in leasing and lease operations. The MMS uses the information to track ownership of leases in the Federal OCS. Responses are mandatory (43 U.S.C. 1334). Proprietary data are covered under 30 CFR 250.197. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Public reporting burden of 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 the Information Collection Clearance Officer, Mail Stop 4230, Minerals Management Service, 1849 C Street, NW, Washington, DC 20240.
MMS FORM MMS-150 (June 2006 – Supersedes all previous editions of form MMS-150 which may not be used) Page 1 of 2
Assignor(s) certifies it is the owner of the record title interest in the above-described lease that is hereby assigned to the Assignee(s) specified above.
DEBARMENT COMPLIANCE: Assignee shall comply with the Department of the Interior’s nonprocurement debarment and suspension regulations as required by Subpart C of 43 CFR Part 42 and shall communicate the requirement to comply with these regulations to persons with whom it does business related to this record title interest assignment by including this term in its contracts and transactions.
Equal Opportunity and Affirmative Action compliance certification: Assignor(s) and Assignee(s) certify that they are in full compliance with Equal Opportunity Executive Order 11246, as amended, and the implementing regulations at 41 CFR 60-01 – Obligations of Contractors and Subcontractors; and 41 CFR 60-2 – Affirmative Action Programs. These requirements are for the purpose of preventing discrimination against persons on the basis of race, color, religion, sex, or national origin. These regulations have specific performance requirements.
Assignee’s execution of 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 bond(s) pursuant to regulations at 30 CFR 256. This assignment is subject to the Outer Continental Shelf Lands Act of August 7, 1953, 67 Stat. 462; 43 U.S.C. 1331 et seq., as amended (the “Act”), and Assignee(s) is subject to, and shall fully comply with, all applicable regulations now or to be issued under the Act. Notwithstanding any agreement between the Assignor(s) and Assignee(s), the parties’ liability to the Minerals Management Service is governed by 30 CFR 256.
This Assignment of Record Title Interest will be made effective between the parties hereto as of _______________, upon approval by the Minerals Management Service, United States Department of the Interior.
This instrument may be executed in any number of counterparts, each of which willl be deemed an original instrument, but all of which together shall constitute but one and the same instrument provided, however, this instrument and any other counterpart hereof, will not be binding unless and until executed by all of the parties, and will not be accepted by the Minerals Management Service unless all counterparts are filed simultaneously.
I certify that the statements made herein by the undersigned are true, complete and correct to the best of my knowledge and belief and are made in good faith.
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.
ASSIGNOR ASSIGNOR
By:________________________ By:__________________________
Name: Name:
Title: Title:
___________________________ _____________________________ Execution Date Execution Date
ASSIGNEE ASSIGNEE
By:________________________ By:__________________________
Name: Name:
Title: Title:
___________________________ _____________________________ Execution Date Execution Date
Attach Notary Acknowledgement (not mandatory)
MMS FORM MMS-150 (June 2006 – Supersedes all previous editions of form MMS-150 which may not be used) Page 2 of 2
File Type | application/msword |
File Title | UNITED STATES |
Last Modified By | blundonc |
File Modified | 2007-03-02 |
File Created | 2007-03-02 |