Form 3000-3a Transfer of Operating Rights (Sublease) in a Lease for O

Form 3000-3a
(July 2012)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

TRANSFER OF OPERATING RIGHTS (SUBLEASE) IN A
LEASE FOR OIL AND GAS OR GEOTHERMAL RESOURCES

FORM APPROVED
OMB NO. 1004-0034
Expires: July 31, 2015
Lease Serial No.

Mineral Leasing Act of 1920 (30 U.S.C. 181 et seq.)
Act for Acquired Lands of 1947 (30 U.S.C. 351-359)
Geothermal Steam Act of 1970 (30 U.S.C. 1001-1025)
Department of the Interior Appropriations Act, Fiscal Year 1981 (42 U.S.C. 6508)

Type or print plainly in ink and sign in ink.
PART A: TRANSFER
1. Transferee (Sublessee)*
Street
City, State, Zip Code

1a. Transferor

*If more than one transferee, check here
separate attached sheet of paper.
This transfer is for: (Check one)

and list the name(s) and address(es) of all additional transferees on page 2 of this form or on a

Oil and Gas Lease, or

Interest conveyed: (Check one or both, as appropriate)

Geothermal Lease

Operating Rights (sublease)

Overriding Royalty, payment out of production
or other similar interests or payments

2. This transfer (sublease) conveys the following interest:
Land Description
Additional space on page 2, if needed. Do not submit documents or agreements
other than this form, such documents or agreements shall only be referenced herein.

Owned

Percent of Interest
Conveyed
Retained

Percent of
Overriding Royalty
Similar Interests
Reserved

a

b

c

d

e

Previously
reserved
or conveyed
f

FOR BLM USE ONLY – DO NOT WRITE BELOW THIS LINE
UNITED STATES OF AMERICA
This transfer is approved solely for administrative purposes. Approval does not warrant that either party to this transfer holds legal or
equitable title to this lease.

Transfer approved effective

By
Bureau of Land Management (BLM)
(Continued on page 2)

(Title)

(Date)

Part A (Continued) ADDITIONAL SPACE for Names and addresses of additional transferees in Item No. 1, if needed, or for Land Descriptions in Item 2, if needed.

PART B – CERTIFICATION AND REQUEST FOR APPROVAL
1. The transferor certifies as owner of an interest in the above designated lease that he/she hereby transfers to the above transferee(s) the rights specified above.
2. Transferee certifies as follows: (a) Transferee is a citizen of the United States; an association of such citizens; a municipality; or a corporation organized under
the laws of the United States or of any State or territory thereof. For the transfer of NPR-A leases, transferee is a citizen, national, or resident alien of the United
States or associations of such citizens, nationals, resident aliens or private, public or municipal corporations; (b) Transferee is not considered a minor under the
laws of the State in which the lands covered by this transfer are located; (c) Transferee’s chargeable interests, direct and indirect, in each public domain and
acquired lands separately in the same State, do not exceed 246,080 acres in oil and gas leases (of which up to 200,000 acres may be in oil and gas options), or
300,000 acres in leases in each leasing District in Alaska of which up to 200,000 acres may be in options, if this is an oil and gas lease issued in accordance with
the Minerals Leasing Act of 1920, or 51,200 acres in any one State if this is a geothermal lease; (d) All parties holding an interest in the transfer are otherwise in
compliance with the regulations (43 CFR Group 3100 or 3200) and the authorizing Acts; (e) Transferee is in compliance with reclamation requirements for all
Federal oil and gas lease holdings as required by sec. 17(g) of the Mineral Leasing Act; and (f) Transferee is not in violation of sec. 41 of the Mineral Leasing
Act.
3. Transferee’s signature to 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 such bond as may be required by the lessor pursuant to regulations 43 CFR 3104, 3134, or 3206.
For geothermal transfers, an overriding royalty may not be less than one-fourth (1/4) of one percent of the value of output, nor greater than 50 percent of the rate of
royalty due to the United States when this assignment is added to all previously created overriding royalties (43 CFR 3241).
I certify that the statements made herein by me are true, complete, and correct to the best of my knowledge and belief and are made in good faith.
Executed this ____________ day of ___________________ 20_________

Executed this ____________ day of ___________________ 20_________

Name of Transferor as shown on current lease _____________________________________________________________________________________________
(Please type or print)

Transferor

Transferee
(Signature)

or

(Signature)

(Title)

or

(Title)

Attorney-in-fact

Attorney-in-fact
(Signature)

(Signature)

(Transferor’s Address)
(City)

(State)

(Zip Code)

Title 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.
(Continued on page 3)

(Form 3000-3a, page 2)

PART C – GENERAL INSTRUCTIONS
1. Transferor/Transferee(s) must complete Parts A1 and A2 and Part B. All parties
to transfer must sign as follows. The transferor(s) must manually sign 3 original
copies and the transferee(s) must manually sign at least 1 of the 3 original
copies. File three (3) completed copies of this form in the proper BLM office for
each transfer of operating rights (sublease). For a transfer of overriding royalty
interest, payment out of production or other similar interest or payment, file one
(1) manually signed copy of this form. The required filing fee (nonrefundable)
must accompany the transfer, payment out of production or other similar
interests or payments. File transfer within ninety (90) days after date of
execution of transferor.
2. Separate form must be used for each lease being affected by this transfer and for
each type of interest conveyed.
3. In Item No. 2 of Part A, describe lands affected (See 43 CFR 3106, 3135 or
3241). For columns b, c, d, and e, enter the interest expressed as a percentage of
total interest in the lease, e.g., if transferor transfers one quarter of a 20%
interest, enter 20% in column b, 5% in column c, and 15% in column d.

(Continued on page 4)

4. If any payments out of production or similar interest, arrangements
or payments have previously been created out of the interest being
transferred, or if any such payments or interests are reserved under
this transfer include a statement giving full details as to amount,
method of payment, and other pertinent terms as provided under
43 CFR 3106, 3135, or 3241.
5. The lease account must be in good standing before this transfer
can be approved as provided under 43 CFR 3106 and 3241.
6. Transfer, if approved, takes effect on the first day of the month
following the date of filing in the proper BLM office. If a bond is
necessary it must be furnished prior to approval of the transfer.
7. Overriding royalty and payment out of production or other similar
types of transfers must be filed with BLM, but will be accepted for
record purpose only. No official approval will be given.
8. Upon approval of a transfer of operating rights (sublease), the
sublessee is responsible for all lease obligations under the lease
rights transferred to the sublessee.

(Form 3000-3a, page 3)

NOTICES
The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following
information required by this oil and gas/geothermal lease transfer application.
AUTHORITY: 30 U.S.C. 181 et seq.; 30 U.S.C. 1001-1025; 42 U.S.C. 6508
PRINCIPAL PURPOSE: The information is to be used to process transfers of operating rights (subleases) for oil and
gas/geothermal resources leases.
ROUTINE USES: (1) The approval of transferee’s rights to the land or resources. (2) Documentation for public
information in support of notations made on land status, records for the management, disposal, and use of public
lands and resources. (3) Transfer to appropriate Federal agencies when concurrence is required prior to granting a
right in public lands or resources. (4)(5) Information from the record and/or the record will be transferred to
appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or
prosecutions.
EFFECT OF NOT PROVIDING INFORMATION: If all requested information is not provided, the transfer may not
be approved. See regulation at 43 CFR Groups 3100 and 3200.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to create and maintain a record of oil and gas/geothermal lease activity.
Response to this request if required to obtain benefit.
BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored
information collection unless it displays a currently valid OMB control number.
BURDEN HOURS STATEMENT: Public reporting burden for 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 U.S. Department of the
Interior, Bureau of Land Management (1004-0034), Bureau Information Collection Clearance Officer (WO-630),
1849 C Street, N.W., Room 2134LM, Washington, D. C. 20240.

(Form 3000-3a, page 4)