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Home My WebLink About20120332.tiff KERR-MCGEE OIL AN GAS ONSHORE DIVISION ORDER Venture Number: 327879 C ' WELD n COUNTY Property Number: 1096609 J t�1 S S 101 R S Property Name: HUDCO 39-18 JSND COMProduct: All Products WELD COUNTY BOARD O COMMISSIONER Status: BEFORE PAYOUT '1011 JAN 2b A II: Ob County/State: WELD/CO PO Box:758 Effective Date: DATES OF FIRST SALES RECEIVED Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER GREELEY,CO 80632 , Interest Amt/Type: 0.00878906/RI • Unit Description: T2N-R65W,Sec 18:E/2SE/4&Sec 17:W/2SW/4 COVERING 160 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• Cler to the rd` Owner Signature 'irporate Ti eK Owner Address(if different from above) By: // ,�> �, ii.,,!!�,, /� William F G. : , hair Pro—Tem Deputy Clerk , Owner Signature rpor: e le FEB 0 12012 City,State Zip Code � Owner Daytime Phone 1861 k1/42•J ktu *Failure to furnish 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 payor. **Insert Tax ID number for all individual parties listed above in the Name and Address box LE ou3 Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: January 19,2012 P.O.Box 173779 p ( y�� Prepared by: KP //O14&/ Denver,CO 80217-3779 `"-n- C1'1C �y Suss y ©�� o� 1-800-677-5603 �� -�a' p• 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. /BY:427/6.dift4“,-- A Cou tai y Attorney DATE: 1-2Z, /2 Hello