ONRR 4437 Certificate of Deposit

U.S. Department of the Interior OMB Control Number 1012-0006

Office of Natural Resources Revenue OMB Approval Expires January 31, 2015

ASSIGNMENT OF CERTIFICATE OF DEPOSIT

Form ONRR-4437

Whereas, on the _____ day of __________, ____, _________________, of _________________

Month Year Company Name Address

____________________________ executed certain certificate(s) of deposit described as follows:

CD Number ________________ in the amount of $__________________

Bank Name_______________________, ABA number _______________

to secure the appealed amounts of principal and/or interest due the United States, Office of Natural Resources Revenue (ONRR). Certificate(s) of Deposit will be redeemed by ONRR in the event that ________________, is unsuccessful in its appeal of Docket No. ______________,

Company Name

appeal amount of $______________ plus interest, and has for a period of more than 15 days

Bill Amount

neglected, failed, or refused to pay such amount although requested to do so by ONRR of the Department of the Interior.

To satisfy the requirements of 30 CFR 1243.4, the undersigned, _________________ as

Company Name

obligator, hereby pledges the Certificate(s) of Deposit as described above, to “the Director of the United States Office of Natural Resources Revenue.”

The condition of the above assignment is such that the Certificate:

(a) shall be pledged to the Director of the United States Office of Natural Resources Revenue in writing and upon the books of the institution issuing such certificates;

(b) shall be issued from a bank that has a minimum Fitch rating or is confirmed by a bank with

an acceptable rating. Acceptable ratings are: “C” for less than 1 million dollars ($1 million);

“B/C” for between 1 and 10 million dollars ($1 million to $10 million); and “B” for over 10

million dollars ($10 million);

(c) shall be conditioned upon the issuing institution waiving all rights of setoff or liens which it

has or may have against those certificates;

(d) shall be of sufficient amount so that liquidation of those certificates prior to maturity would

provide the required surety amount;

(e) shall remain in full force and effect until the assignment is released in writing by the Director of the United States Office of Natural Resources Revenue;

Form ONRR-4437 (revised 10/2011) Page 1 of 2

U.S. Department of the Interior OMB Control Number 1012-0006

Office of Natural Resources Revenue OMB Approval Expires January 31, 2015

The assignment shall be valid throughout any maturity redemption period as designated by the

issuing institution and shall also automatically renew itself when the CD is renewed.

If there are penalties for early redemption, such penalties will be paid out of the obligor’s interest

earned, not out of the principal amount of the CD.

In Witness Whereby, the obligor has hereunto set its signature and seal this ______ day of

__________, ______.

Month Year

______________________________

Company Name

By: ___________________________

In Witness Whereof, the Issuing Institution has here unto set its signature and seal this

_________ day of ____________, ______.

Month Year

______________________________

Issuing Bank

By: __________________________

Title: _______________________

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 allow lessees, designees, or payors to stay the effectiveness of an order or decision by posting a surety instrument. The ONRR uses the information to secure the financial interests of the public and Indian lessors during the entire administrative and judicial appeal process. Responses are required to obtain a benefit (43 U.S.C. 1334). Proprietary information is protected in accordance with standards established by the Federal Oil and Gas Royalty Management Act of 1982 (30 U.S.C. 1733), the Freedom of Information Act (5 U.S.C. 552(b)(4)), and Department regulations (43 CFR 2). 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 for this form is estimated to average 2 hours 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 Regulatory Group, Office of Natural Resources Revenue, PO Box 25165, MS 64000A, Denver, CO 80225.

Form ONRR-4437 (revised 10/2011) Page 2 of 2