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HomeMy WebLinkAbout20130728.tiffKERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER Venture Number: 328269 Property Number: 1098578 Property Name: OVERLOOK 21-30 NB -CD Product: All Products WELD COUNTY BOARD OF COMMISSIONER Status: BEFORE PAYOUT County/State: WELD/ CO PO Box: 758 Effective Date: DATES OF FIRST SALES Owner Number: RV37471404 - WELD COUNTY BOARD OF COMMISSIONER GREELEY, CO 80632 Interest Amt/Type: 0.03570092 / RI Unit Description: T2N-067W, Sec 30: E/2NW/4 & W/2NE/4 COVERING 160 ACRES, M/L OF 'HIE NIOBRARA CODELL FORMATION The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by KERR-MCGEE OIL AND GAS ONSHORE (Payor). Payor shall be notified, in writing, of any change in ownership, decimal interest. or payment address. All such changes shall be effective the first day of the month following receipt of such notice. Payor is authorized to withhold payment pending resolution of a title dispute or adverse claim asserted regarding the interest in production claimed herein by the undersigned. The undersigned agrees to indemnify and reimburse Payor any amount attributable to an interest to which the undersigned is not entitled. Payor may accrue proceeds until the total amount equals 1100, or Sept. 30 whichever occurs first, or as required by applicable state statute. This Division Order does not amend any lease or operating agreement between the undersigned and the lessee or operator or any other contracts for the purchase of oil or gas. In addition to the terms and conditions of this Division Order, the undersigned and Payor may have certain statutory rights under the laws of the state in which the property is located. Note: NADOA Model Form Division Order (Adopted 9/95) RV37471404 WELD COUNTY BOARD OF COMMISSIONER Attest : m'w-stale. , Cl = k to he Board Ow VCr Signature/Corporafe Title� By: ri r'lliaui F. Garcia, Chair �.... ...• 4.1 �. Deputy Cie *Tax ID ft XXX-XX-0813 **Tax ID iF Owner Address (it different from above) Signature/Corporate Title City. State Zip Code MAR 1 8 2013 970-356-4000 Owner Daytime Phone 2013-0728 *Failure to furnish your Social Security/Tax ID number will result in withholding tax in accordance with federal law and any tax withhele wn1 not ne reruneaoie oy payui. **Insert Tax ID number for all individual parties listed above in the Name and Address box Consen i Gt4endCt vitt KERB-MCGEE OII, AND GAS ONSHORE P.O. Box 173779 Denver, CO 80217-3779 1-800-677-5603 Olkg Date Prepared: March 06, 2013 Prepared by. Kr) St,: Leb3bl COUNTY ATTORNEY STAFF APPROVAL This is to affirm the attached Division Order and authorization to receive payment for an oil and gas well has been reviewed by the County Attorney's staff as to form and legal description. a.- Nei LM) k> 2-1-30 34 6- CO Assis nt County Atto ey Date of signature: \--? -7 Additional Comments: Hello