Form BOEMRE Form MMS-15 BOEMRE Form MMS-15 Assignment of Record Title Interest in Federal OCS Oil a

U. S. Department of the Interior OMB Control Number: 1010-0006

Bureau of Ocean Energy Management, OMB Approval Expires: xx/xx/xxxx

Regulation and Enforcement

Lease No.

ASSIGNMENT OF RECORD TITLE INTEREST IN

FEDERAL OCS OIL AND GAS LEASE Lease Effective Date

New Lease No. (BOEMRE Use Only)

Part A: Assignment

Legal description of the OCS oil and gas lease or the officially designated subdivision of the lease being assigned:

Assignor(s) does (do) hereby sell, assign, transfer, and convey unto Assignee(s) the following undivided right, title and interest (insert name and qualification number of each Assignor and Assignee below):

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.

For BOEMRE use only

This Assignment of Record Title Interest has been filed as of the date stamped on this document, is effective between the Assignor(s) and Assignee(s) as of _______________________, and is hereby approved by the Bureau of Ocean Energy Management, Regulation and Enforcement on the date shown below.

By__________________________________ ______________________ _____________________

Authorized Official for BOEMRE Title BOEMRE 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. BOEMRE uses the information to track ownership of leases in the Federal OCS. Responses are required to obtain or retain a benefit.  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 5438, Bureau of Ocean Energy Management, Regulation and Enforcement, 1849 C Street, NW, Washington, DC 20240.

BOEMRE FORM MMS-150 (Mo/Year – Supersedes all previous editions of form MMS-150 which may not be used) Page 1 of 2

Part B: Certification and Acceptance

1. Each Assignor 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.

2. DEBARMENT COMPLIANCE: Each Assignor and Assignee certifies its compliance with the Department of the Interior’s nonprocurement debarment and suspension regulations at 2 CFR Subtitle B, Part 1400, and agree to communicate the requirement to comply with these regulations to persons with whom it does business related to this record title interest assignment by including the terms of the regulations in its contracts and transactions.

3. Equal Opportunity and Affirmative Action compliance certification: Each Assignor and Assignee certifies that it is 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.

4. QUALIFICATIONS of ASSIGNOR(S) and ASSIGNEE(S): Each Assignor and Assignee certifies that it: is established and officially recognized by the Bureau of Ocean Energy Management, Regulation and Enforcement as qualified and authorized to bid on, acquire interests in, and hold OCS oil and gas leases; is exercising and meeting due diligence requirements on any other OCS lease in accordance with section 8 of the OCSLA, as amended (43 U.S.C. 1337(d)); is in good standing with acceptable operating performance as required by 30 CFR 250 and 256; is not disqualified by BOEMRE from acquiring any new OCS leases or assigned interest(s) in existing leases because of unacceptable operating performance on any other OCS lease; is not failing to meet or exercise due diligence (as determined by BOEMRE after notice and opportunity for a hearing under 30 CFR part 290, subpart A); and is not restricted from bidding or acquiring interests in the lease or officially designated subdivision, therein, or grouped with any other entities on the restricted joint bidders list.

5. 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 250 and 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 (are) 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 Bureau of Ocean Energy Management, Regulation and Enforcement is governed by 30 CFR 250 through 256.

This Assignment of Record Title Interest will be made effective between the parties hereto as of the date recorded by BOEMRE on the face of this form, upon approval by the Bureau of Ocean Energy Management, Regulation and Enforcement, United States Department of the Interior.

This instrument may be executed in any number of counterparts, each of which will 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 Bureau of Ocean Energy Management, Regulation and Enforcement unless all counterparts are filed simultaneously.

By signing this document, you certify that your statements made herein are true, complete and correct to the best of your 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 Name: Assignor Name:

Assignor Qualification No. Assignor Qualification No.

By:___________________________________ By:___________________________________

Signatory Name: Signatory Name:

Signatory Title: Signatory Title:

______________________________________ ______________________________________

Execution Date Execution Date

Assignee Name: Assignee Name:

Assignee Qualification No. Assignee Qualification No.

By:___________________________________ By:___________________________________

Signatory Name: Signatory Name:

Signatory Title: Signatory Title:

______________________________________ ______________________________________

Execution Date Execution Date

BOEMRE FORM MMS-150 (Mo/Year – Supersedes all previous editions of form MMS-150 which may not be used) Page 2 of 2