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EERII-OGEE OIL AP ;AS ONSHORE DIVISION
Venture Number: 327418 A P j 6 5—
Property Number: 1095297
W�' Property Name: MARKHAM 35-8 NB-CD
f+H rLL��'''__COUNTY Product: All Products
WELD COUNTY BOARD OF COMMISS ON ktipER S Status: BEFORE PAYOUT 0201 7 MAR 2b A IQ. 2 ounty/State: WELD/CO S
PO Box:758 �ffective Date: DATES OF FIRST SALES
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER
RECEIVED GREELEY,CO 80632 Interest Amt/Type: 0.06250000/RI
Unit Description:
T2N-R65W,Sec 8:S/2SW/4 : Sec 1 :N/2NW/4 OVERING 160
ACRES,M/L OF THE NIOB' CODELL 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-to t h Board Owner Signature/CdFporate Title �J Owner Address(if different from above)
`� `;� , ._ _A, Sean P. Conway, Chair
V Owner Signature/Corporate Title State Code
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By: Deputy C e .r�❑"�-r�.oardCity, Zip
[leeo\ APR 04 70'? 970-356-4000
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; ' � Owner Daytime Phone
1161 t 1.......billiV I
atiglefill
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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 withhe
**Insert Tax ID number for all individual parties listed above in the Name and Address box 2012-0920
Retum to: KERR-MCGEE OIL AND GAS ONSHORE / r' / Date Prepared: March 20,2012/ -,,,v
��/ /l P.O.Box 173779 Qt_d 1 Lt"( CA C l"1�.1` V iii) Prepared by: KP LL- ��✓
7 Denver,CO 80217-3779 (! - j- 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.
BY: Ad D��
County Attorney
DATE: 3 -Z'9 -/z
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