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oe. _ie a.m. oa-oa-zoos 3 474241 6686 <br />Eran:rs~oi~ Eaui~xnent ~~ ' ~ 970 241 X86 ~/~"'?007 08:38 #221 P.003/004 <br />REMl1'iVITX NON~REFUNDAJ~LEflQaBOArTLJG1T10NF~+~tplvglDBRATION <br />COI.oItADO STATE BOARD OF LAND [OMML~IOI~tERS ~~Jt,) ~~ %~~•'1 <br />LEASE ASSIGNMENT APPLICA'TIUN .AND RIDER - <br />O Q ~ ~•• ~ . -: ~. fic : 1~g <br />LEASE NUiVIBER ~ +i `7~ ~ ...: ~~ Tr~, ~' <br />:~ :. _f~.:uGi ~3Etn:Z%~ <br />i/ ~ j <br />Uwe,.. _~YO / d ~~ w ~ C F- <br />(tssigttor name p~dnted) <br />~ sv IIF G ,~, c ~,rs SIC <br />(assignor name printod) <br />ASSIGNO ` ,r <br />~, <br />(assignor sigaaturo <br />(~ a~ <br />whose address is f, v ~o X 17 ~~ ,~ i lipp ~ <br />~~=07 <br />(~~~ ..- <br />~~~ <br />(~> <br />atxltgTieox; crrr, sr~~re, zm, Foleamanro ~oi~le~ss dt r~sow+t. Its~aesfaNT~nvlss alas. tr nt'ei.tc~etx <br />individually and as of <br />PHONE numbet: (,$~) vs"8"J ~ i~c'r~ FAX ntnnbd : ~ L <br />rite Bolder of m i is lase aurnbew ~ ~ d 4? rcqugt that . tL~ .Slats Soprd . of :Land Co~sioners . assign thus. interest to the <br />Assigtt~. [ undorasattd that of a hsue is wboUy tt tilt disct+stioa of tka Staff Board od Lund Coaotaislonextsad bacoinaa sffmctive. qnb- <br />apps receipt of the t>Igaod tgtprovat surd <hrt t stn eapoosfbte 1'or tmy lwe thu beooate dtte trait the tai~IS+ttem is .pprovad. ~ ~ <br />Sts$e tiott+d of Lmd Cooomissionees apptavel of dtis asar~at yrplicadost, my rights and iatrrest is thifi leax strut be aaasferrad, in whole or iu <br />per. to the Assignee. <br />OSse at~ked,J6r adt&iorrol signcairra <br />^ ti+r.~z rirer~ro~nrr~wris ..~~~..>~~~ - -- .J.~.:.:...:.tr...if...l.~awwt_ <br />COUNTY A ~ SUBDIiYIS10Pl N TDWAT$HIP RANG19: DRAW <br />1 awe y _ J . <br />wll wS97G1V88S/WYA77At!8.It6Ql/IRBD <br />ASSIGNEE(S) <br />t, tha .ysiDta. agout slat tee scree eottd ~ i.wd Coasa~siwttes asml~a-skis lease m me er sigotus Iseteir. t sis-sib my thw these ~uT 6e <br />other atlAarhed ases oa dw ptepeaty. Farlker; ! adenraoA iclt wOr rgponib~y w lone reodvsd ud naiewed a eupy of tit least ~ tb~t tk~at. t[ <br />riproved. fa !br the twitlt~R tans et tin lefre wy. t oatib talc all of tilt ielettnetiot prsnrmea-oo t~ Ictae ~ ~ ttge aer. ax+swi. r <br />mtdastasd trot wpply>eu $ba+x iasowraessd'oemstioo is earn i6r oetoeBsNOa ottey losto itnod e s rttalc dteis ktte sppiiatiaa <br />t know rata 7Srst Tian Lnde art only ee wed i^ rmordsaoe wi6 good ttramos oetaarsHaa patdiees, t ardartttotd teat >s .dditim q tks tams etAie kite, <br />tee snr. Ho.M otttnd Coasnlstioat:s will ttgsiet mtt a ~tttttts taeiuoe ptsa 6aptavided s taoaditioa ot'tppesvfes flit tJf7onsfptoral, <br />tlw altiR~aN.-fill r.come sn t~tnentnoiec.ieaoe. t.~eeto eta ot$~e iatG <br />c~7y P!-rddYrl+ `rr~. ~YN/~~N~--WyO~r_ ~~ ~1~~ <br />O <br />(ssssigttee ttatne ) (~8~- sue) <br />(address) <br />irtdividttall3r aid as <br />Afio•.zy~~.~7 <br />(p>~ne~ <br />(~) <br />t~h~? <br />of <br />The assignee ro4~ the ta~se be held ts: <br />~ an individual O Joint trawtn ^ tangy in cotnmoa <br />O a corpors2ian ar aote~y a ray entity reabtered with the Sectetary of Store - sloth copy of the txrt~att oertifscatt; of good standing, Articles of <br />tncmporation tlOng with a list of the e~ty's ~icees/direotees tad s~ddtol~r: Picase specify whether corporation of onmptny <br />^ a trust- iodttdt a cofPl' o1'Dodaruioa of Twt g'ihutee <br />o a ptrtnetship - ttttch lief; of partaas and Articles ofPtrtaers4~ <br />O other - n)sne speedy .._ p Sss a[mrhtd jot ~dMoteaf <br />