HomeMy WebLinkAbout20122384.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 322334
Property Number: 1070554
Property Name: RIVERBEND 23- 19 NB-CD
Product: All Products
WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE
County/State: WELD/ CO
PO Box : 758 Effective Date: DATES OF FIRST SALES
Owner Number: RV37471404 - WELD COUNTY BOARD OF COMMISSIONER
GREELEY, CO 80632 Interest Amt/Type: 0.00084555 / RI
Unit Description :
TIN R66W SEC 19: SWSW SURFACE; NESW BH
CODELL NIOBRARA FORMATION 160 AC SPACING
E2SW; W2SE SEC 19 TIN R66W
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)
RECEIVED
AUG 2 7 2012
WELD COUNTY
COMMISSIONERS
RV37471404
WELD COUNTY BOARD OF COMMISSIONER *Tax ID # XXX-XX-0813
"Tax ID #
Attest : •
Cler to the rd Owner Signature/Corporate Title §BDO 5 2012 Owner Address (if different from above)
B : / Sean P . Conwa , Chair
Deputy Clerk Owner Signature/Corporate Title City, State Zip Code
uv' 970-356-4000
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
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Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: August 22, 2012
AL-Cit
P.O. Box 173779 � '- i Prepared by Tena Murphy
Denver, CO 80217-3779 �G1 Susp:
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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: ,f9 1d l t c �✓
C unty Attorney
DATE: ?-2 42—
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