HomeMy WebLinkAbout20122611.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 318864 RECEIVED
Property Number: 1093626
Property Name: MORTON 9-1 NB-CD
Product: All Products SEP 1 7 2012
WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE WELD COUNTY
County/State: WELD/CO
PO Box: 758 Effective Date: DATES OF FIRST SALESCOMMISSIONERS
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSION
GREELEY,CO 80632 Interest Amt/Type: 0.00454207/RI
Unit Description:
TIN R67W SEC l:N2SE
WELD COUNTY,CO
80.0075 AC M/L
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$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)
RV37471404
WELD COUNTY BOARD OF COMMISSIONER *Tax ID#XXX-XX-0813
**Tax ID#
Attest•
Clerk e Bo. d ` / Owner Signature/Corporate Title Owner Address(if different from above)
B I) �, -. �, t.I� ✓�j Sean P. Conway, Chair
•��
Deputy Cler ���• rd Owner Signature/Corporate Title City,State Zip Code
970-356-4000
SEP 2 6 2012 Owner Daytime Phone
It61
(L9 kJ
(0--itAm4itt al-24424J
2012-2611
9- /c- o7O/c4
•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
Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: September 12,2012
P.O.Box 173779 Prepared by: Sam Wiselogel
Denver,CO 80217-3779 Susp: N •
,
1-800-677-5603 LC l a L/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: 64//alC
Couy Attorney
DATE: 26212
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