HomeMy WebLinkAbout20120365.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 318735
Property Number: 1093281
WELD COUNTY
COMMISSIONERS Property Name: DENVER 23-18 NB-CD
Product: All Products
WELD COUNTY COLORADO Status: NOT APPLICABLE
C/O BOARD OF COIMYJA*N I'0ISA O 55 County/State: WELD/CO
915 10TH STREET Effective Date: DATES OF FIRST SALES
RECEIVED Owner Number: RV37471504-WELD COUNTY COLORADO
GREELEY,CO, 80631 Interest Amt/Type: 0.00003906/RI
Unit Description:
TIN R66W SEC 18: SESE(SURF)SWSE(BH)
CODELL NIOBRARA FORMATION
160 AC SPACING W2SE,E2SW SEC 18
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 COLORADO *Tax ID#XXX-XX-0813
C/O BOARD OF COUNTY COMMIS **Tax ID#
Attest:
Clerk to the Bo a
♦ sl Signature/Corporate Title Owner Address(if different from above)
By; , ,/i� �� '.i���i� S' :an P. Conway, Chair
Deputy Clerk to%tC O Mfr Signature/Corporate Title City,State Zip Code
(Li �j FEB 0 6 2012
Owner Daytime Phone
o?oia-o3(FS"
*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
L LO VI
Return to: KERR-MCGEE OIL AND GAS ONSHORE / Date Prepared: January 21,2012
P.O,Box 173779 .G : Kerr.tie-Gee ( I o/Jj) Prepared by: Tena Murphy
Denver,CO 80217-3779 -. -/a 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.ESSI County Attorney
DATE: ,l2
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