Test Form 2 - Trust Lands Administration

MINERAL LEASE ASSIGNMENT FORM

Form E-5 (Rev 08-2023)

Form completed for:(Required)

Record Title Interest

Operating Right Interest

Overriding Royalty

Assignment Date(Required)

ML ("the Lease")(Required)

The undersigned, as owner of the interest hereinafter specified in and to the ML# ("the Lease") above for good and valuable consideration, the receipt of which is hereby acknowledged, does hereby apply for approval of this assignment, and hereby assigns to:

Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

the following rights, title, and interest in the Lease, to the extent indicated, subject to the limitations on creation of overriding royalties as provided in Rule 850-21-600(2)(h) for leases set out below:

County(Required)

1. Land affected by this assignment are located in the above County, Utah, and described below:

Legal Description

T(Required)

R(Required)

Sec(Required)

Further description

(If needed, attach separately)

Accepted file types: pdf, docx, rtf, Max. file size: 50 MB.

Containing # of Acres(Required)

2. Specify interest of assignor before assignment in above-described lands as a % of 100% *(Required)

3. Specify interest being conveyed to assignee by this assignment as a % of 100% *(Required)

4. Specify interest being retained by Assignor after assignment as a % of 100% *(Required)

5. Specify overriding royalty reserved to Assignor in this assignment(Required)

6. Specify previously reserved overriding royalties(Required)

*% should be shown to 6 decimal places, i.e. 1.000000%

It is hereby certified that the statements made herein are true, complete, and correct to the best of the undersigned's knowledge and belief and are made in good faith. For leases issued April 1, 2005 or thereafter, Assignor certifies that royalties of whatsoever nature burdening the captioned lands, including royalties to Lessor, do not exceed twenty percent of one hundred percent (20% of 100%). Any royalty in excess of twenty percent of one hundred percent, including Lessor's royalty, are not recognized as valid by the Agency. Approval of this assignment extends only to such rights, interests and title as are held by assignor in the subject lands. Overriding royalty reservations set out in items 5 and 6 are for informational purposes only and are not approved under this assignment.

Executed on this date(Required)

By(Required)

(Signature of Assignor or Officer/Agent/Attorney-in-Fact)

Company

Signer's Title

Notary Acknowledgment (Assignor)

On this date, personally appeared before me, signer(s) of the above instrument, who duly acknowledged to me that he/she/they executed the same. Given under my hand and seal this date.

STATE OF(Required)

COUNTY OF(Required)

Date(Required)

Seal(Required)

Accepted file types: png, jpeg, avif, webp, Max. file size: 50 MB.

Notary Public(Required)

INSTRUCTIONS: Assignment form(s) must be submitted with the appropriate fee per lease. For a current list of fees, please refer to our website. Please note, fee amounts are approved by the Utah State Legislature.

INDIVIDUAL'S ACCEPTANCE OF ASSIGNMENT (ASSIGNEE)

STATE OF(Required)

COUNTY OF(Required)

I, (we), on oath, do solemnly swear that I am (we are) at the present time of legal age, and I (we) hereby assume and agree to perform all of the covenants and obligations of said lease on the part of lessee(s) to be kept and performed, and accept the foregoing instrument.

Individual's Name(Required)

By: (Individual's signature)(Required)

On this date, personally appeared before me, signer of the above instrument, who duly acknowledged to me that he/she executed the same.

Given under my hand and seal this date(Required)

Seal(Required)

Accepted file types: png, jpeg, avif, webp, Max. file size: 50 MB.

Notary Public(Required)

ACCEPTANCE OF ASSIGNMENT – CORPORATE (ASSIGNEE)

STATE OF(Required)

COUNTY OF(Required)

Corporation Name(Required)

Corporation State(Required)

Assignor(Required)

Assignor State(Required)

of ML No.

which assignment is dated

The undersigned Assignee corporation, incorporated in the state identified in this form, hereby accepts the assignment from the Assignor identified above of the mineral lease referenced in this form, dated as shown, subject to all of the covenants and obligations of said Lessee, and represents that it has legal capacity to do business in the State of Utah.

IN WITNESS WHEREOF, Assignee has executed this acceptance this date.

Date(Required)

By:

(Signature of Assignee Officer/Agent/Attorney-in-Fact)

Company

Signer's Title

Notary Acknowledgment (Corporate Assignee)

On this date, personally appeared before me (the undersigned), who being by me duly sworn did say, each for himself, that (he, she, or they) is an officer, agent or Attorney-in-Fact for the assignee and is authorized to accept this assignment and has executed the same and the seal affixed is the seal of said corporation. Given under my hand and seal this date.

Date(Required)

Seal(Required)

Accepted file types: png, jpeg, avif, webp, Max. file size: 50 MB.

Notary Public(Required)

Terms & Acknowledgements

Property Description

The subject lease covers the number of acres identified on this form.

Execution

This instrument has been executed on the date shown on this form.

Assumption and Acceptance (Assignee)

The undersigned, on oath, do solemnly swear that they are at the present time of legal age, hereby assume and agree to perform all of the covenants and obligations of said lease on the part of the lessee(s) to be kept and performed, and accept the foregoing instrument.

Signer Acknowledgment

The signer(s) of the above instrument personally appeared before a notary public on the date shown on this form and duly acknowledged that they executed the same, as given under the notary's hand and seal.

Corporate Acknowledgment (Assignee)

The person accepting this assignment personally appeared before a notary public on the date shown on this form and, being duly sworn, stated that they are an officer, agent, or Attorney-in-Fact for the assignee, that they are authorized to accept this assignment and have executed the same, and that the seal affixed is the seal of said corporation, as given under the notary's hand and seal.

MINERAL LEASE ASSIGNMENT FORM

Legal Description

Notary Acknowledgment (Assignor)

INDIVIDUAL'S ACCEPTANCE OF ASSIGNMENT (ASSIGNEE)

ACCEPTANCE OF ASSIGNMENT – CORPORATE (ASSIGNEE)

Notary Acknowledgment (Corporate Assignee)

Terms & Acknowledgements

Property Description

Execution

Assumption and Acceptance (Assignee)

Signer Acknowledgment

Corporate Acknowledgment (Assignee)

Services

Organization

Resources

Questions?