HomeMy WebLinkAbout20122388.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 318601
Property Number: 1092879
Property Name: BADDING 16-26SX SUSX
Product: All Products
WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE
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. 12500000 / RI
Unit Description:
T2N-R66W, Sec 26: S/2SE/4 COVERING 80 ACRES, M/L OF THE
SUSSEX 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 $ 100, 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)
RECEIVED
AUG 2 7 2012
WELD
ERS
COUNTY
CMM ISI
RV37471404
WELD COUNTY BOARD OF COMMISSIONER *Tax ID # XXX-XX-0813
��� * *Tax ID #
Attest : �..----r „r
Cler 1•D the rd Owner Signature/Corporate Title 0 5 2012 Owner Address (if different from above)
By : Sean P . Conway , Chair
Deputy Clerk IL Owner Signature/Corporate Title City, State Zip Code
1 1k
970-356-4000
Owner Daytime Phone
1861 r,�C etritA ✓ di) /o? 2012-2388
Failure to furnish your Social Secuoty/Tax ID number will result in withholding tax in accordance with federal law and any tax withheld will not be refundable by payor.
**Insert Tax ID number for all individual parties listed above in the Name and Address box
LE DO ? q
Return to: KERR-MCGEE OIL AND GAS ONSHORE CC l hl 1'Y1 LE t Date Prepared: August 23, 2012
P.O. Box 173779 LO21 G Prepared by. KP
Denver, CO 80217-3779 q - t O - la Susp: N
1 -800-677-5603
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, legal description, and percentage
of royalties, if applicable.
V e f 441-
our(y Attorney
DATE: er-2e-72_
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