Form 3000-3a Transfer of Operating Rights (Sublease) in a Lease for O

Form 3000-3a
(January 2010)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES

FORM APPROVED
OMB NO. 1004-0034
Expires: July 31, 2012
Lease 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: TRANSFER

1. Transferee (Sublessee)*
Street
City, State, Zip Code

1a. Transferor

*If more than one transferee, check here
separate attached sheet of paper.
This transfer is for: (Check one)

and list the name(s) and address(es) of all addtional transferees on page 2 of this form or on a

Oil and Gas Lease, or

Interest conveyed: (Check one or both, as appropriate)

Geothermal Lease
Operating Rights (sublease)

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

2. This transfer (sublease) conveys the following interest:
Land Description
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.

Owned

b

a

Percent of Interest
Retained
Conveyed

c

Percent of
Overriding Royalty
Similar Interests
fnterests
Reserved

Previously
reserved
or conveyed

e

f

d

FOR BLM USE ONLY - DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
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

By

Bureau of Land Management (BLM)
(Continued on page 2)

(Title)

(Date)

Part A (Continued): ADDITIONAL SPACE for Names and addresses of additional transferees in Item No. 1, if needed, or for Land Description in Item 2, if needed.

PART B - CERTIFICATION AND REQUEST FOR APPROVAL
1. The transferor certifies as owner if an interest in the above designated lease that he/she hereby transfers to the above assignee(s) the rights specified above.
2. Transferee certifies 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, transferee 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 Mineral Leasing Act of 1920, or 51,200 acres in any one State if this is a geothermal lease; (d) All parties holding an interest in the transfer are
otherwise in compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing 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

20

day of

Name of Transferor as shown on current lease

Executed this

day of

20

____________________________________________
(Please type or print)

Transferor
or
Attorney-in-fact

Transferee
(Signature)

or
Attorney-in-fact

(Signature)

(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, fictitious, or
fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 3)

(Form 3000-3a, Page 2)

PART C - GENERAL INSTRUCTIONS
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 office for each
transfer of operating rights (sublease). For a transfer of overriding royalty
interest, payment out of production or other similar interest or payment, file one (1)
manually signed copy of this form. The required filing fee (nonrefundable) must
accompany the transfer, payment out of production or other similar interests
or payments. File assignment within ninety (90) days after date of execution
of assignor.
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.

(Continued on page 4)

4 . If any payments out of production or similar interests, 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 first day of the month following the
date of filing in the proper BLM office. If a bond is necessary it must be furnished prior to approval of the transfer.
7. Overriding royalty and payment out of production or other similar types of transfers
must be filed with BLM, but will be accepted for record purposes only. No official
approval will be given.
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.

(Form 3000-3a, page 3)

NOTICES
The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following
information required by this oil and gas/geothermal lease transfer application.
AUTHORITY: 30 U.S.C. 181 et seq.; 30 U.S.C. 1001-1025; 42 U.S.C. 6508
PRINCIPAL PURPOSE: The information is to be used to process transfers of operating rights (subleases) for oil
and gas/geothermal resources leases.
ROUTINE USES: (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)(5) 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.
EFFECT OF NOT PROVIDING INFORMATION: If all requested information is not provided, the transfer may
not be approved. See regulations at 43 CFR Groups 3100 and 3200.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to create and maintain a record of oil and gas/geothermal lease activity.
Response to this request is required to obtain benefit.
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
Officer (WO-630), 1849 C Street, N.W., Mail Stop 401 LS, Washington, D.C. 20240.

________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________

(Form 3000-3a, page 4)