HomeMy WebLinkAbout20120841.tiff '1 1E DIVISION ORDER
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TO: CHESAPEAKE OPERATING, INC., PAYOR PROPERTY NO: 636675
P.O. BOX 18496 EFFECTIVE: 11/4/2011
OKLAHOMA CITY,OK 73154 PREPARED BY: GWEN HILLHOUSE
DATE PREPARED: 2/28/2012
PRODUCT/ZONE: OIL&GAS WELD COUNTY
This agreement is made and entered into on February 28,2012. ��7�u`��� C S I DANLRR.5CC
The undersigned severally and not jointly certifies it is the legal owner of the interest set out below of all the oil, 2aMAElalh2ligtk hydlbodrtlons produced
from the property described below:
OPERATOR CHESAPEAKE OPERATING,INC. OWNER NO: 406096 Iee€IV
PROPERTY: VARRA 12-9-66 1H OWNER: WELD COUNTY '
LEGAL DESCRIPTION: SECTION 12-9N-66W UNIT ACRES: 640.000000
WELD COUNTY,CO COMMENTS N/A
BPO BPO BPO AP01 AP01 AP01 AP02 AP02 AP02
Status Net Ac Lse NRI/RI Unit Int Net Ac Lse NRI/RI Unit Int. Net Ac Lse NRI/RI Unit Int.
PA 1.200000 0.20000000 0.00037500 N/A N/A N/A N/A N/A N/A
DIVISION OF INTEREST
THIS AGREEMENT DOES NOT AMEND ANY LEASE OR OPERATING AGREEMENT BETWEEN THE INTEREST OWNERS AND THE LESSEE OR
OPERATOR OR ANY OTHER CONTRACTS FOR THE PURCHASE OF OIL OR GAS.
The following provisions apply to each interest owner("Owner)who executes this agreement:
TERMS OF SALE: The undersigned will be paid in accordance with the division of interest set out above. The payor shall pay all parties at the price agreed
to by the operator for oil and gas to be sold pursuant to this division order. Purchaser shall compute quantity and make corrections for gravity and
temperature and make deductions for impurities in the oil.
PAYMENT: From the effective date, payment is to be made monthly by payor's check,based on this division of interest,for oil runs within 60 days after the
end of the month of production and for gas within 90 days after the end of the month of production from the property listed above,less taxes required by law
to be deducted and remitted by payor as purchaser. Payments of less than $100.00 may be accrued before disbursement until the total amount equals
$100.00, or until July 31st of each year,whichever occurs first. However, the Payor may hold accumulated proceeds of less than $10.00 until production
ceases, or the Payor's responsibility for making payment for production ceases, whichever occurs first. Payee agrees to refund to payor any amounts
attributable to an interest or part of an interest that payee does not own.
INDEMNITY: The owner agrees to indemnify and hold payor harmless from all liability resulting from payments made to the owner in accordance with such
division of interest,including but not limited to attorney fees or judgments in connection with any suit that affects the owner's interest to which payor is made
a party.
DISPUTE:WITHHOLDING OF FUNDS: If a suit is filed that affects the interest of the owner,written notice shall be given to payor by the owner together
with a copy of the complaint or petition filed. In the event of a claim or dispute that affects title to the division of interest credited herein,payor is authorized to
withhold payments accruing to such interest,without interest unless otherwise required by applicable statute,until the claim or dispute is settled.
TERMINATION: Termination of this agreement is effective on the first day of the month that begins after the 30th day after the date written notice of
termination is received by either party.
NOTICES: The owner agrees to notify payor in writing of any change in the division of interest, including changes of interest contingent on payment of
money or expiration of time. No change of interest is binding on payor until the recorded copy of the instrument of change or documents satisfactorily
evidencing such change are fumished to payor at the time the change occurs.Any change of interest shall be made effective on the first day of the month
following receipt of such notice by payor. Any correspondence regarding this agreement shall be fumished to the addresses listed unless otherwise advised
by either party. In addition to the legal rights provided by the terms and provisions of this division order,an owner may have certain statutory rights under the
laws of this state.
SIGNATURE OF SOCIAL SECURITY/
WITNE SIGNATURE INTEREST OWNER TAX ID NUMBER MAILING ADDRESS FOR PAYMENT
Attest. •
G
Cler to the oa Sean P. Conway, Ch 84-6000-813 P.O. Box 758
By: Board of Weld County Greeley, CO 80632
Deput Bd Commissioners
M • r;' CELL PHONE NUMBER CORRESPONDENCE ADDRESS
a` 1�
1b61 xr�..�C
1150 0 Street
�� � P.O. Box 758
WO O((1( �g Greeley, CO 80632
ONEN R FAX NUMBER EMAIL ADDRESS
970-356-4000 X4200 970-352-0242
Failure to furnish your Social Security/Tax I.D.number will result in withholding tax in accordance with federal law,and any tax withheld will not
be refundable by payor.
MAR 2 6 2012
THIS COPY CAN BE RETAINED FOR YOUR RECORDS
34/ao7� Cone 3I21II,, OWNER NO:406096 L.60,3 9 5-
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Chesapeake Operating, Inc.
DIVISION ORDER DEPARTMENT
Chesapeake INSTRUCTION SHEET
ENERGY 1-877-CHK-1GAS (1-877-245-1427)
We are pleased to deliver this Division Order which sets forth your share of production proceeds from the recently
completed well indicated thereon and the name and address to which payments will be made. ELEASEREnnan
Your Division Order contains information that will aid in your communication with Chesapeake. If there is a title
requirement set out below your name, that requirement is more fully explained in the enclosure. Documentation
resolving the title requirement must be delivered with your Division Order. Please do not alter the Division Order in any
way unless you submit documentary evidence to support the change.
SIGNATURES
• Sign exactly as shown on the Division Order. If your signature is different, please provide legal documentation
authorizing the name change.
• Signatures by Agents, Attorneys-in-Fact, Guardians, or Trustees must be verified by attaching a copy of the recorded
legal evidence of the rights vested in the signatory party.
• In the event of multiple trustees/executors, all signatures are required unless documentation is provided evidencing
.• authority to sign on behalf of all parties.
• An authorized official, with the name and title of the signing party printed beneath the signature, must execute for
companies, corporations, or partnerships.
• All signatures must be witnessed. No Notary is required.
TAXPAYER IDENTIFICATION NUMBER OR SOCIAL SECURITY NUMBER
Include your Social Security Number or Tax Identification Number in the space provided beside your signature. Failure
to furnish this number will result in 28%withholding tax in accordance with Section 3406 of the Internal Revenue
Service,and any tax withheld will not be refundable by Chesapeake.
ADDRESS AND TITLE CHANGES
• Please note any change of address directly on the Division Order.
• Subsequent address changes and transfers of title must be submitted in writing either by mail, fax or email. You must
sign your request and include your owner number, social security number, or tax id number, old address, new
address, and telephone number.
PAYMENTS
Chesapeake must receive the signed Division Order by the 20th of the month in order for you to receive payment at our
end-of-the-month distribution. If we receive the Division Order after the 20th, it will be held for the next month's
accounting cycle. Our policy is to remit checks monthly when your account reaches $100, or at the end of July,
whichever occurs first. We can reduce the minimum hold on your account from $100 to $25 upon written request.
Chesapeake offers an electronic funds transfer(EFT) option for your convenience. If you elect to receive EFT payments,
your revenue detail will be available online at www.chk.com and will no longer be mailed to you. If you would like to
request an enrollment form, please contact our Revenue or Division Order Department.
CONTACT US:
The following information will assist us in serving you: (1) name & owner number (2) county and state where well is
located (3)well name and property number (4)telephone number with area code (5) nature of your inquiry (6) analyst
name on the division order.
Revenue Inquiry Division Order/Title Inquiry Correspondence
1-877-CHK-IGAS 1-877-CHK-IGAS Chesapeake Operating Inc.
fax: 405.849.0030 fax: 405.879.9563 P.O. Box 18496
revinquiry@chk.com inquirydo@chk.com Oklahoma City, OK 73154-0496
Chesapeake is proud to be the nation's most active driller of new wells in the U.S. and a leader in exploring for much-
needed supplies of clean burning natural gas for our country. We highly value our nearly 100,000 royalty owners and
industry partners and are proud that Chesapeake's capital, drilling expertise and risk-taking is helping to increase the
value of your minerals and working interests.
Please visit our website at www.chk.com to learn more about our Fortune 500 company. We have provided an Owner
Relations page for you that may answer some of your specific revenue or ownership inquiries and save you a call. Our
website also provides a form for submitting your specific inquiry.
Owner No: 406096 Owner: WELD COUNTY
Int Type: 2 Comments: N/A
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 applicably
C nt Attorney
DATE: *24/ 7—
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