HomeMy WebLinkAbout20120919.tiff KERR-MCGEE OIL AN 3AS ONSHORE DIVISION ORDER
Venture Number: 327431 /112) 0 5-I 2 3-53007
WELD Property Number: 1095312
U Y Property Name: Mi A R KH A M 35-8 JSND nC I„ ISSf0NER S Product: All Products
WELD COUNTY BOARD Op1V�AM IS SIONER Status: NOT APPLICABLE
ri A 10: 20 County/State: WELD/CO
PO Box:758 Effective Date: DATES OF FIRST SALES
Owner Number: RV37471404-WE
GREELEY,CO 80632 ����'��® Interest Amt/Type: 0.06250000/RILD COUNTY BOARD OF COMMISSIONER
Unit Description:
T2N-R65W,Sec 8:S/2SW/4& ec N/2NW/4 OVERING 160
ACRES,M/L OF THE J-SAND I RMATION
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#
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Attest• Clerk the o a r d Owner Signature/Co orate Title Owner Address(if different from above)
Sean P. Conwa 4
By: Deputy C rk to the Board Owner Signature/Corporate Title, i City,State Zip Code
0O1► 970-356-4000
�,,� . . 4\ 'APR 0 4 2012 Owner Daytime Phone
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*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
2012-0919
Return to: KERR-MCGEE OIL AND GAS ONSHORE C/� Date Prepared: ...a ... ,
❑ ❑ ❑ O173779 r p g er 0/1ts.C%1ce_ `''htj,Prepared by: KP
�j? Denver,CO 80217-3779 l V t�^,e^�I n j 1 Susp:
1-800-677-5603 Cf 1. 1 J�
Check out the new Anadarko Owner Relations Website: Go to www.anadarko.com, click on
• About Anadarko, then click on Owner Relations. Our new owner relations website provides
- details in regards to owner issues. This is a helpful tool to utilize for issues about royalty checks,
owner interest questions and much more!
Dear Interest Owner:
1. Enclosed are two copies of your Division Order or Transfer Order. Please execute the first copy in front of two
witnesses and provide a valid Social Security Number or Tax Identification number. The second copy marked
"Copy" is for your records.
a. Sign exactly as shown on the Division Order or Transfer Order. Signatures must be witnessed by two
people. If joint ownership, all owners will be required to sign, but may sign separate copies.
Signatures by Agents, Attorneys-in-Fact, Guardians or Trustees must be verified by attaching evidence
of the right to sign in that manner, such as a copy of the Power of Attorney.
b. Include the correct Social Security Number or Tax Identification Number in the space provided.
Failure to furnish this information may result in withholding tax in accordance with
federal law and any tax withheld will not be refundable by payor. If the name on the Division
Order or Transfer Order does not match the name on your Social Security Card, please advise us, in
writing, of the differences.
2. Please address all correspondence, including your executed Division Order, to the following address:
Kerr McGee
Attn: Division Orders
P.O. Box 173779
Denver, CO 80217-3779
3. For CHANGE OF ADDRESS, please submit all changes to the above address. All ADDRESS CHANGES
MUST BE MADE IN WRITING.
4. NAME AND OWNERSHIP CHANGES must be submitted in writing to the above address.
In order to process the name and ownership changes, we require the following documentation:
a. Name Changes: Marriage Certificate, Divorce Decree, etc.
b. Ownership Changes: Deeds, Assignments, etc., must be recorded in the County (Parish) in which
the property is located prior to sending them to our office. Copy of the document sent in must have
evidence of the recording (e.g., the recording stamp) on it.
c. Changes due to Death of an Owner: As a general rule, we require complete copies of probate
proceedings rendered by a court having jurisdiction over the property in question. If the Estate was
not probated, or if it was probated in a different state, other documentation may be required.
5. Anadarko Customer Relations toll-free telephone number: 1-800-359-1692. Our Customer Relations
Agents are committed to monitoring and returning calls in a timely manner. Our goal is to return your call
within two business days.
6. When you wish to make an inquiry or request a change, please have available as much of the following
information as you can:
-Owner Number
-County and State where well is located
-Well name and/or property number
-Your telephone number with AREA CODE
7. For access to check history information: http://www.oildex.com, or refer to the attached instruction sheet.
For Technical Questions related to this website please call: 1-888-922-1222 (option 3).
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: zet'a/407,1- ��—
County Attorney
DATE: 3-29 -/Z
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