Form F Form F Assignment of Lease

Osage Form F OMB Control No. 1076-XXXX

Revised May 2013 Expires: XX/XX/XXX

CONTRACT NUMBER

__________________________

U.S. DEPARTMENT OF THE INTERIOR

BUREAU OF INDIAN AFFAIRS

OSAGE AGENCY

813 Grandview, P.O. Box 1539

Pawhuska, Oklahoma, 74056

(918) 287-5740 FAX: (918) 287-5786

OSAGE MINING LEASES

(Must be executed in duplicate)

Assignment of ____________________Lease

WHEREAS, the Secretary of the Interior has heretofore approved _______________mining lease, dated _____________________

_________________________20____, entered into by and between _________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________, lessee, and the Osage Nation, lessor, covering the following described land in the Osage Reservation, State of Oklahoma:_______________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

Now, therefore, for and in consideration of ($______________) dollars, the receipt of which is hereby acknowledged, the said _________________________________________________________________________________________________________,

the lessee in the above described lease, hereby bargains, sells, transfers, and assigns and conveys _________________________

_________________________________________________________________________________________________________

right, title and interest of the lessee in and to said lease, subject to the approval of the Secretary of the Interior, to:

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

_________________________________________________________________________________________________________

In Witness whereof the said lessee has hereunto set ________hand this _______day of _______________________ 20______.

ATTEST: _______________________________________________________

Secretary _______________________________________________________

(SEAL) _______________________________________________________

ACKNOWLEDGMENT OF INDIVIDUAL

STATE OF ________________________________________COUNTY OF ___________________________________, SS:

Before me, a Notary Public, in and for said County and State on this _____________ day of ____________________ 20_____, personally appeared ________________________________________________________________________________________ to me known to be the identical person _________ who executed the within and foregoing and annexed instrument for the consideration and purposes therein mentioned and set forth, and I do hereby so certify.

______________________________________________________ My commission expires ______________________________ Notary Public

ACKNOWLEDGMENT OF CORPORATION

STATE OF ________________________________________________COUNTY OF ___________________________________, SS:

On this _____________ day of _____________________________ 20_____, before me, a Notary Public, within and for the State and County aforesaid, personally appeared ____________________________________________________ and_____________

__________________________________ to me personally known who, being by me duly sworn did each say that____________ ___________________________________________ is the ______________ president and ______________________________

________________________________________ is the secretary of _________________________________________________

_________________________, a corporation, and that the seal affixed to the foregoing and annexed instrument is the corporate seal of said corporation, and that said instrument was signed and sealed on behalf of said corporation by authority of its board of directors; and said __________________________________________________________________________________________ and ____________________________________________________________ duly acknowledged that they each had in their said official capacities executed the foregoing instrument as the act and deed of the said company for the consideration and purposes therein mentioned and set forth, I do hereby so certify.

Witness my hand and seal on this _________________ day of ____________________________________________ 20 ______.

______________________________________________________ My commission expires ______________________________ Notary Public

ACCEPTANCE BY ASSIGNEE

The assignee to the above and foregoing assignment, made subject to the approval of the Secretary of the Interior, hereby accepts such assignment and agrees to fulfill all the obligations, conditions and stipulations in said described indenture of lease, when assigned, and the rules and regulations of the Secretary of the Interior, so far as applicable thereto and to furnish proper bond guaranteeing a faithful compliance with said lease and this assignment.

In Witness Whereof, the said assignee hereunto set ______ hand and seal the ____ day of _______________________ 20 ____.

ATTEST: _______________________________________________________

Secretary _______________________________________________________

(SEAL) _______________________________________________________

CONSENT OF SURETY

The _______________________________________ of ___________________________________________________________

surety for ____________________________________________________________________________________on the bond accompanying the lease above described, hereby consents to the assignment and transfer of said lease as above made and agrees that their original bond shall remain in full force and effect.

Dated at ______________________________________________ this _________________ day of _______________20 ______

_______________________________________________________

U.S. DEPARTMENT OF THE INTERIOR

BUREAU OF INDIAN AFFAIRS

OSAGE AGENCY

Pawhuska, Oklahoma

Approved:

Under the authority delegated by

209 DM 8, 230 DM 1, 3 IAM 4.1

and Muskogee Area Addendum

9901 to 3 IAM 4 issued June 22, 1999.

The within assignment is hereby approved pursuant to authority delegated by 25 CFR 226.

_______________________________________________________

SUPERINTENDENT