HomeMy WebLinkAbout20120336.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 328000
Property Number: 1096941
WELD COUNTY Property Name: CARTER 36-32 JSND
WELD COUNTY BOARD tIFCO�P(ISSIMP Status:
t Product: BEFORE PAYOUT
2812 JAN 26 A 11: OS County/State: WELD/CO
PO Box:758 Effective Date: DATES OF FIRST SALES
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER
GREELEY,CO 80632 RECEIVED Interest Amt/Type: 0.00115434/RI
Unit Description:
. T2N-R66W,Sec 32:SE/4SW/4,SW/4SE/4&TIN-R66W Sec 5:
NE/4NW/4,NW/4NE/4 COVERING 154.16 ACRES,M/L OF
THE J-SAND 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)
WELD COUNTY BOARD OF COMMISSIONER *Tax ID#XXX-XX-0813
/ / — **Tax ID#
Attest: / / ,+,"/ if v
Cle k to the oar Owner Signature/Corporate Title - Owner Address(if different from above)
By:Ny1r1.ie , tik )William F. Garcia, Chair Pro-Tem
Deputy Cle and Owner Signature/Corporate Title% City,State Zip Code
74 La FEB 0 12012
( 7 .•
Owner Daytime Phone
1861 Twill
•
^<,:,(_ "�v�`l .
*Failure to famish your Social Security/Tax ID number will result in withholding tax in accordance with federal law and any tax withheld will not be refundable by payer.
**Insert Tax ID number for all individual parties listed above in the Name and Address box
LEDO )N
Return to: KERR-MCGEE OIL AND GAS ONSHORE /I Date Prepared: January 19,2012 L Li 0
P.O.Box 173779 CV yr-m t-`tbr °1'vfj)\ Prepared by: KP �9 1 �j �{
Denver,CO 80217-3779 d. a_ I a Susp: N , /6�/.Jf -egg
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.
A.Yj fi4//417i,-L-6,
ounty Attorney
DATE: /"24 /2
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