HomeMy WebLinkAbout20122649.tiff 0211435237
KERR-MCGEE OIL&GAS ONSHORE LP
' r Owner Number: 374714
PO BOX 1330
HOUSTON,TX 77251-1330 - Check Date. 06/25/12
Check Number: 0211435237
Check Amount: $51,422.67
WELD COUNTY
Acting on behalf of itself and/or its affiliates. COMMISSIONERS ADJUSTMENT CODE PRODUCT CODE
C. COMPRESSION 100... OIL
D. DEHYDRATION 300.40F CONDENSATE
1011 JUN 28 A O26 F_ GATHL ERING 4� 206 GAS
PRODUCTS
I IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIII M SERVICE FEE 40D SULPHUR
���+++ //��/� {�T P.. PROCESSING 209. HELIUM
0010? (KA 001 005 17412 - 021143523➢ NNNNNNNN io g r I V C U R... TREATING 409.. PASOTNENDENSAIE
WELD COUNTY BOARD OF COMM 1`V` CMr1 • T SEVERANCE ANSPORTATION 409 GASOLINE -
V. AD VALOREM TAX INTEREST TYPE
PO Box 758 I STATE WITHHOLDING WI WORKING INTEREST
GREELEY CO 80632 X OTHER DEDUCTS PP PRODUCTION PAYMENT
Z. SETTLEMENT OR.. OVERRIDING ROYALTY
GAIN/LOSS RI ROYALTY INTEREST
CR SURFACE OWNER
•MAY INCLUDE OTHER MI MINERAL INTEREST UNLEASED
TAXES RU. NON PARTICIPATING ROYALTY
DL. BLANCHARD
FOR APC'S SSN POLICY CALL 800-359-1692
OR EMAIL OWNER.RELATIONS@ANADARKO.COM
ACCESS YOUR CHECKSTUB ONLINE RETAIN THIS STATEMENT ANY QUESTIONS PLEASE CALL
WITH OUR SECURE WEBSITE AT FOR TAX PURPOSES OUR OWNER RELATIONS HOTLINE AT
http://www.oildex.com DUPLICATES CANNOT BE FURNISHED 800-359-1692
PROD PROD I INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER ADJ OWNE
R
DATE CODE(TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS/ NET DECIMAL GROSS ADJUSTMENTS CODE NET
I VALUE TAXES VALUE INTEREST VALUE /TAXES VALUE
12/11 204 RI 0.00 1.200 0.00 0.00 0.00 1.00000000 0.00 1,061.35 S 1,061
04/12 204 RI 264.14 1.844 1.136 487.04 0.00 487.04 0.00494822 2.41 0.00 S 2
04/12 400 RI 935.49 0.512 478.96 0.00 478.96 0.00494822 2.37 0.00 S 2
04/12 300 RI 0.76 102.736 78.08 0.00 74.05 0.06068359 4.74 0.00 S 4
(4.03) (0.24) T
04/12 204 RI 173.19 1.844 1.136 319.31 0.00 319.31 0.00494822 1.58 0.00 S 1
04/12 400 RI 613.15 0.511 313.24 0.00 313.24 0.00494822 1.55 0.00 S 1
04/12 300 RI 11.95 102.733 1,227.66 0.00 1,164.37 0.06068359 74.50 0.00 S 7C
(63.29) (3.84) T
04/12 100 RI 2.57 102.735 264.03 0.00 250.43 0.06250000 16.50 0.00 S It
(13.60) (0.85) T
-•PE'TY: 112 4411/11/4 SHAFE- 7-2• C+UNTY: WEU STATE: C•
04/12 204 RI 0.90 1.956 1.191 1.76 0.00 1.76 0.06250000 0.11 0.00 S C
04/12 400 RI 3.17 0.656 2.08 0.00 2.08 0.06250000 0.13 0.00 S C
�ni --_Q At b
0211435237
HOW TO HEAD YOUR CHECK DE IAIL 15. Owner Number,
To help you understand the essential information which accompanies your cheek.we are t 16. Check Dale:
providing a sample check stub witn dehnitions/explanations of the various columns and lines on it. 7
1 . Check Number:
17. Check Amount
. ADJUSTMENT CODE PRODUCT CODE
Property quantity may be rounded to the nearest whole number for purposes of display on this check stub. When C.. COMPRESSION 100 OIL
DEthe property quantity is less than 10 mcf,such rounding may materially affect the price shown on this check for
F D . GATHERING TRATION 300, CONDENSATE
display purposes only,but does not affect the precision of the underlying calculation of value. In such situations, .. F 400 2 2 06 GAS
F.. SERL 400 LIQUID PRODUCTS
more precise information about property quantities and prices can be obtained by calling the number provided on M SERVICE FEE qpD. SULPHUR
this check stub. P PROCESSING 209 HELIUM
R. TREATING 40C PLANT CONDENSATE
S SEVERANCE TAX'
T.. TRANSPORTATION 409 GASOLINE
V AD VALOREM TAX INTEREST TYPE
I. STATE WITHHOLDING WI... WORKING INTEREST
X OTHER DEDUCTS PP. PRODUCTION PAYMENT
ACCESS YOUR CHECKSTUB ONLINE RETAIN THIS STATEMENT ANY QUESTIONS PLEASE CALL Z SETTLEMENT GAIN/LOSS RR_.OVERRIDING TY ROYALTY
WITH OUR SECURE WEBSITE ATRI R ROYALTY INTERESTW
FOR TAX PURPOSES FURNISHED CUR OWNER RELATIONS 35 HOTLINE AT •MAY INCLUDE OTHER TAXES MR_.SURFACE INTEREST OWNER
MipJ/www.oildex.com DUPLICATES CANNOT BE 900359-1692
RUI. MINERALIN ROYALTY
SED
BL NON PARTICIPATING ROYALTY
BL... 0LANCHARD
1 2 3 4 5 6 7 8 9 10 11 12 13 14
PROD PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER ADJ OWNEI
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS/ NET DECIMAL GROSS ADJUSTMENTS CODE NET
VALUE TAXES VALUE INTEREST VALUE [TAXES VALUE
18.PROPERTY: 0010000000001 SMITH AH COUNTY: RUSK STATE:TEXAS
02/04 203 WI 10000.00 5.000 1.333 50,000.00 (100.00) 49,900.00 0.01000000 500.00 (1.00) 5 499.
02/04 204 WI 1,000.00 5.000 1.333 5000000 ` (55000 F�4,950.00 0.01000000 50.00 (.50) S 49.
PROPERTY: 0010001210002 DAVIS .0004 A lfy�. iJ STATE:LOUISIANA
03/04 100 RI 1,000.00 27.000 ^ li�p'�1e1'�i■ ( 6,800.00 0.01000000 270.00 (2.00) S 268.
03/04 400 RI 2,000.00 25.000 50,000.00 (500.000) 48,500.00 0.01000000 500.00 (5.00) S 485.
(1,000.000) (10.00) T
TOTALS 1,320.00 1,301.
1. PRODUCTION DATE- Month and year that product was sold. 11.OWNER GROSS VALUE -Your share of property gross value.
2. PRODUCT CODE- Code used to identify product sold. See PRODUCT CODE legend 12.OWNER ADJUSTMENTS/TAXES -Your share of property taxes and/or adjustments.
in upper right-hand corner of settlement statement. 13.ADJUSTMENT CODE-Code used to identity type of adjustment made.See
3. INTEREST TYPE - Type of interest owned. See INTEREST TYPE legend in upper ADJUSTMENT CODE legend in upper right-hand corner of settlement statement.
right-hand corner of settlement statement. 14.OWNER NET VALUE -Your share of property net value.
4. PROPERTY QUANTITY - Total volume of product sold from properly shown in barrels 15.OWNER NUMBER-Your owner number. This number is uniquely assigned to you and
(oil,condensate).MCF(gas,helium),gallons(liquid products),or tons(sulphur). should be included on all correspondence with Anadarko.
5. PRICE- Price per unit. 16.CHECK DATE&CHECK NUMBER
6. BTU(BRITISH THERMAL UNIT)-Heating value of gas. 17.CHECK AMOUNT-1 he total amount payable to you for this check.
7. PROPERTY GROSS VALUE-Total value of product sold from properly. 18.PROPERTY -Properly number,properly name,and county and state where properly ir
8. PROPERTY ADJUSTMENTS/TAXES-Total amount of taxes and/or adjustments for located.
property.
9. PROPERTY NET VALUE-Total value of properly atter deduction of taxes and/or
adjustments.
10.OWNER DECIMAL INTEREST-Percentage of product sold attributable to your
ownership interest (as shown on Division Order). If others are marketing their product
separately,decimal shown may be inflated.
00107 CKA 001 005 17412 - 0211435237 NNNNNNNNNNNN
0211435237
KERR-MCGEE OIL&GAS ONSHORE LP ' do
2 , //�lJ
Owner Number: 374714 0d6/( a-i&�'
Check Date: 06/25/12
Check Number: 0211435237
Check Amount: $51,422.67
WELD COUNTY BOARD OF COMMISSIONER
DJ
PROD PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNERADJ OWNER
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS! NET DECIMAL GROSS ADJUSTMENTS CODE NET
VALUE TAXES VALUE INTEREST VALUE !TAXES VALUE
04/12 100 RI 38.21 102.732 3,925.42 0.00 3,649.06 0.00878906 34.50 0.00 S 32
(68.95) (0.61) G
(202.37) (1.78) T
(5.04) (0.04) X
•-•-ERTY: ••294527.1112 HWC• .-I COUNTY: WEL• STATE'. C•
04/12 204 RI 443.96 1.884 1.159 836.27 0.00 836.27 0.00878906 7.35 0.00 S 7
04/12 400 RI 1,991.34 0.418 832.85 0.00 832.85 0.00878906 7.32 0.00 S 7
-• E-TY: •1245 :1n11 :UTCH 3-1 C•UNTY: WEL• STATE: C•
04/12 100 RI 25.32 102.733 2,601.20 0.00 2,418.06 0.00144602 3.76 0.00 S 3
(45.69) (0.07) G
(134.11) (0.19) T
(3.34) 0.00 X
04/12 300 RI 142.94 102.732 14,684.64 0.00 13,650.75 0.00142190 20.88 0.00 S 1€
(257.94) (0.37) G
(757.07) (1.08) T
(18.88) (0.03) X
PROPERTY: 0029476600001 HUDCO 9-18 CN
04/12 300 RI 254.38 102.732 26,133.20 0.00 24,293.25 0.00878906 229.69 0.00 S 212
(459.04) (4.03) G
(1,347.31) (11.84) T
(33.60) (0.30) X
PROPERTY: 0029476600002 HUDCO 9-18 CN
04/12 204 RI 725.67 1.882 1.159 1,365.33 0.00 1,365.33 0.00878906 12.00 0.00 S V
04/12 400 RI 3,254.39 0.418 1,360.78 0.00 1,360.78 0.00878906 11.96 0.00 S 1'
04/12 204 RI 73.14 2.500 1.092 182.85 0.00 182.85 0.00005469 0.01 0.00 S
04/12 400 RI 219.42 0.833 182.85 0.00 182.85 0.00005469 0.01 0.00 S
04/12 300 RI 64.52 102.733 6,628 33 0.00 6,286.60 0.00001133 0.08 0.00 S
(341.73) 0.00 T
R• E-TY: 112 521 3 CLC GUI G•UNTY'. WEL• STATE: C•
04/12 204 RI 53.55 1.811 1.071 97.00 0.00 97.00 0.00494822 0.48 0.00 S (
04/12 400 RI 189.77 0.639 121.26 0.00 121.26 0.00494822 0.60 0.00 S I
•-•-E-TY: •12 521 4 CLC GU1 UUNTY: WEL• STATE: C•
04/12 204 RI 16.81 1.667 1.071 28.02 0.00 28.02 0.00142746 0.04 0.00 S I
04/12 400 RI 60.25 0.698 42.03 0.00 42.03 0.00142746 0.06 0.00 S I
04/12 204 RI 89.33 1.833 1.136 163.70 0.00 163.70 0.00494822 0.81 0.00 S I
04/12 400 RI 316.07 0.512 161.67 0.00 161.67 0.00494822 0.80 0.00 5 I
-R•PERTY: 1129545 11112 WILLIAMS 41-341 C•UNTY: WEL• STATE: C•
04112 204 RI 1,581.34 1.941 1.131 3,069.74 0.00 3,069.74 000284063 8.72 0.00 S
04/12 400 RI 5,581-86 0.607 3,386.57 0.00 3,386.57 0.00284063 9.62 0.00 S
04/12 204 RI 690.69 1.942 1.131 1,341.25 0.00 1,341.25 0.00284063 3.81 0.00 S
04/12 400 RI 2,437.84 0.607 1,478.55 0.00 1,478.55 0.00284063 4.20 0.00 S
•
04/12 204 RI 491.54 1.883 1.159 925.30 0.00 92530 0.03329720 30.81 0.00 S 3
04/12 400 RI 2,094.89 0.458 960.14 0.00 960.14 0.03329720 31.97 0.00 S 3
P. E-TY' •12555.11.12 :UCKLEN I2-37 C-•LINTY: WEL• STATE: C•
04/12 204 RI 807.88 1.886 1.160 1,523.29 0.00 1,523.29 0.03329717 50.71 0.00 S 5
04/12 400 RI 3,410.52 0.478 1,629.98 0.00 1,629.98 0.03329717 54.29 0.00 S 5
(peen ,...* La. , " ",. ranee)
0211435237
Page: 3
r
PROD PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER R OWNER STM I, ADJ OWNER
DATE CODE TYPE QUANTITY PRICE BTU GROSS LU ADJUSTMENTS/ NET RES VALUE ADJUSTMENTS ICODE NET
VALUE TAXES VALUE INTEREST VALUE (TAXES I VALUE
112 5. 511112 FI"EST+NE 12-31 UUNTY: WEL• - STATE: C+
04/12 204 RI 558.01 1.807 1.073 1,008.33 0.00 1,00833 0.02046330 20.64 0.00 S 20.
04/12 400 RI 898.58 0.370 332.68 0.00 332.68 0.02046330 6.79 0.00 S 6.
PROPERTY: 0029585400001 MUSE 1 COUNTY: WELD • STATE: CO
04/12 300 RI 61.26 102.732 6,293.42 0.00 5,850.33 0.00439453 27.66 0.00 S 25.
(110.54) (0.49) G
(324.46) (1.43) T
(8.09) (0.04) X
04/12 204 RI 797.58 1.906 1.135 1,520.07 0.00 1,520.07 0.00439453 6.68 0.00 S 6.
04/12 400 RI 3,054.02 0.694 2,118.54 0.00 2,118.54 0.00439453 9.31 0.00 S 9.
PROPERTY'. 0029585500001 MUSE 2 COUNTY: WELD • STATE: CO
04/12 300 RI 3.22 102.732 330.80 0.00 307.50 0.00878906 2.91 0.00 S 2.
(5.81) (0.05) G
(17.06) (0.15) T
(0.43) 0.00 X
•R•-E-TY: 112 5:5511112 MUSE2 C•UNTV: WEU . ST•TE. C•
04/12 300 RI 0.05 102.800 5.14 . 000 4.78 0.00439453 0.02 0.00 S 0.
(0.09) 0.00 G
(0.26) 0.00 T
(0.01) 000 X
PROPERTY: 0029585500003 MUSE 2 COUNTY: WELD STATE: CO
04/12 204 RI . 22.41 1.879 1.159 42.10 0.00 42.10 0.00878906. 0.37 0.00 5 0.
04/12 400 RI 100.69 0.418 42.10 0.00 42.10 0.00878906 0.37 0.00 S 0
•-••E-TY. 112 5'5511114 MUSE2 COUNTY' WEL• ST•TE'. C•
04/12 204 RI 23.21 1.863 1.159 43.24 0.00 4324 0.00439453 0.19 0.00 S 0.
04/12 400 RI 104.68 0.413 43.24 0.00 43.24 0.00439453 0.19 0.00 S 0.
04/12 300 RI 57.80 102.732 5,937.96 0.00 5.631.83 0.03125000 185.56 0.00 S 175.
(306.13) (9 57) T
04/12 300 RI 5.96 102.733 612.29 0.00 580.72 0.00071016 0.43 0.00 S 0
(31.57) (0.02) T
P•••E•TV. 112 6 2 n111 '•NKIN J WALTE• UNIT2 UUNTY: WEL• - ST•TE'. C•
04/12 300 RI 1.09 102.733 111.96 0.00 104.10 0.00072107 0.08 0.00 S 0
(1.97) 0.00 G
(5.77) 0.00 T
(0.14) 0.00 X
04/12 300 RI 16.34 102.733 1,678.66 0.00 1,592.12 0.00198979 3.34 0.00 S 3
(86.54) (0.17) T
04/12 300 RI 12.08 102.732 1,241.01 000 1,177.03 0.06068359 75.31 0.00 S 71
(63 98) (3.88) T
04/12 300 RI 5.68 102.732 583.52 0.00 553.44 0.06068359 35.41 0.00 5 33
(30.08) (1.83) T
•R+•E'TY: 112711211111 WEL•UUNTY ••LING UT2 .C•UNTY.:.WEU STATE: C•
04/12 300 RI 0.07 102.714 7.19 0.00 6.82 0.06068359 0.44 0.00 S 0
(0.37) (0.021 T
'••E'TV'. 112 71/211/12 WEU COUNTY •••LING UT2 COUNTY: WPL• ' STATE'.-C•
04/12 300 RI 0.20 102.750 20.55 0.00 1949 006068359 1.25 0.00 S 1
(1.06) (0.06) T
04/12 300 RI 9.12 102.732 936.92 0.00 870.96 0.06250000 58.56 0.00 S 54
(16.46) (1.03) G
(48.30) (3.02) T
(1.20) (0.07) X
04/12 300 RI 8.41 102.732 863.98 0.00 803.15 0.03125000 27.00 0.00 S 25
(15.18) (047) G
(44.54) (1.39) T
(1.11) (0.04) X
04/12 300 RI 16.76 102.732 1,721.80 0.00 1,600.58 0.06250000 107.61 0.00 S 100
(30.24) (1.89) G
(88.77) (5.55) T
(2.21) (0.14) X
PR••E'TV: 112 77 711112 HS•-FREEL•N• 3-2 C+UNTV: WEU ST•TE: C•
04/12 300 RI 9.43 102.732 968.77 0.00 900.55 0 03125000 30.27 000 S 28
(17.02) (0.53) G
(49.95) (1.56) T
(1.25) (0.04) X
PROPERTY' 0029833800001 HSR-BIR B 14-21 COUNTY: WELD . STATE: CO
04/12 100 RI 1.43 102.734 146.91 0.00 136.56 0.00062500 0.09 0.00 S 0
(2.58) 0.00 G
UIILIII LILA LAIC 1111] 1(41e - uc LLni][ir nnnnnnnnnnnn
0211435237
KERR-MCGEE OIL&GAS ONSHORE LP T , Page: 4
Owner Number: 374714
Check Date: 06/25/12
Check Number: 0211435237
Check Amount: $51,422.67
WELD COUNTY BOARD OF COMMISSIONER
ZNNaZN
PROD 1PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER O OWNEE R OWNER ADJ OWNEI
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS/ NET DECIMAL GROSS ADJUSTMENTS CODE NET
jVALUE TAXES VALUE INTEREST VALUE /TAXES VALUE
' -__�_- __ . -_ _ __-__-_.. (7.58) ___. .-.._. 0.00 T
(0.19) 0.00 X
•'••E'TV: 112 :34511111 HS'-:I' : 13-21 C•I1NTY'. WEL• STATE: C•
04/12 300 RI 0.55 102.727 56.50 0.00 52.53 0.00062500 0.04 0.00 S 1
(0.99) 0.00 G
(2.91) 0.00 T
(0.07) 0.00 X
'R• E-TY'. I12 :42211111 HS•-SEEN :-32 C•UNTY: WEL• SPTE: C•
04/12 100 RI 114.87 102.732 11,800.93 0.00 11,192.53 0.00117343 13.85 0.00 S ti
(608.40) (0.71) T
04/12 100 RI 29.35 102.732 3,015.21 0.00 2,802.91 0.00144602 4.36 0.00 S
(52.97) (0.08) G
(155.45) (0.23) T
(3.88) 0.00 X
04/12 100 RI 268.30 102.732 27,563.24 0.00 25,622.60 0.00144602 39.86 0.00 S 3
(484.16) (0.70) G
(1,42104) (2.05) T
(35.44) (0.05) X
04/12 100 RI 171.90 102.732 17,659.79 0.00 16,416.42 0.00144602 25.54 0.00 S 2
(310.20) (0.45) G
(910.46) (1.32) T
(22.71) (0.03) X
04/12 100 RI 20.50 102.732 2,108.02 0.00 1,997.44 0.00284062 5.98 0.00 S
(108.58) (0.31) T
04/12 100 RI 42.27 102.732 4,342.52 0.00 4,118.64 0.00284062 12.34 0.00 S 1
(223.88) (0.64) T
•-•'E'TV'. 112 :: 14111 HS--SEKICH 3-1 C•UNTV'. WEL• STATE: C•
04/12 300 RI 63.40 102.733 6,513.27 0.00 6,054.70 0.00144602 9.42 0.00 $
(114.41) (0.17) G
(335.79) (0.49) T
(8.37) (0.01) X
•••E-TV'. 112 13: 1 HSR-MILLE' FE•EAL 15-.A UUNTY: WEU STATE'. C•
04/12 300 RI 3.69 102.731 379.08 0.00 359.54 0.00070770 0.27 0.00 5
(19.54) (0.01) T
'•'E'TV 112 13-11112 HS'-MILLE' FE•E'AL 15--• C•UNTY: WEU ST•TE: C.
- 04/12 300 RI 37.35 102.732 3,837.07 0.00 3,566.92 0.00142190 5.46 0.00 S
(67.40) (0.10) G
(197.82) (0.28) T
(4.93) (0.01) X
04/12 300 RI 87.41 102.732 8,979.88 0.00 8,347.64 0.00142812 12.82 0.00 S 1
(157.73) (0.23) G
(462.96) (0.66) T
(11.55) (0.02) X
"••E'TY: 1131:2611011 VINCENT I-2 • N:-C• UUNTY'. WEL• STATE: C•
04/12 300 RI 175.82 102.732 18,062.50 0.00 17,131.28 0.12136719 2,192.19 0.00 S 2,01
(931.22) (11302 T
.-7/2i -1_ainCie.
00107 CKA 001 005 17412 - 0211435237 NNNNNNNNNNNN
0211435237
Page: 5
PROD PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER ADJ OWNER
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS) NET DECIMAL GROSS ADJUSTMENTS CODE NET
VALUE TAXES VALUE INTEREST VALUE /TAXES I VALUE
'-•'ERTV: ••31:544,1 ni •CKE- 3-1 N:-C• C•UNTY'. WEU ST•TE. C•
04/12 •300 RI 361.17 102,732 37,104.04 0.00 • 35,191.12 0.00211289 78.40 0.00 S 74.:
(1,912.92) (4.04) T
'-• ERTY: 1.31:57•nni :A••ING 2d-2 JSN• C•UNTV: WEL•
STATE: C•
04/12 300 RI 10.41 102.732 1,06945 0.00 1,014.31 0.06250000 66.84 0.00 S 63.:
(55.14) (3.45) T
1131:57 nut :•••ING 24-2 JSN• C+LINTY: WELK
STATE'. C•
34/12 204 RI 1,381.26 1.992 1.185 2,750.72 0.00 2,750.72 0.06250000 171.92 0.00 S 171.!
54/12 400 RI 4,891.89 0.644 3,151.52 0.00 3,151.52 0.06250000 196.97 0.00 S 196.!
•'E-TY. .131:6 1 :A••ING b-2 JSN• U UNTV' WEL• STATE: C•
34/12 300 RI 9.09 102.732 933.84 0.00 885.70 0.06250000 58.36 0.00 S 55.:
(48.14) (3.01) T
r
)4/12 204 RI 1,255.36 1.992 1.185 2,500.00 0.00 2,500.00 0.06250000 156.25 0.00 S 156:
)4/12 400 RI 4446.02 0.644 2,864,32 0.00 2,864.32 0.06250000 179.02 0.00 5 179.1
--• E-TV: ••31'655''n1 =A••ING 39-26 JSN• •Ca LINTY: WEL• STATE: C•
)4/12 300 RI 13.62 102.732 1,399.22 0.00 1,327.09 0.06250000 87.45 0.00 S 821
(72.13) (4.51) T
i
)4/12 204 RI 1,406.26 1.991 1.185 2,800.48 000 2,800.48 0.06250000 175.03 0.00 S 175.(
34/12 400 RI 4,980.43 0.644 3,208.48 0.00 3,208.48 006250000 200.53 0.00 S 200.'.
"•'E-TV: 11311.5.11111 :A••ING4• C•
-2 JSN. C•UNTY'. WEU
STATE
34/12 300 RI 7.15 102.732 734.54 0.00 696.67 0.03125000 22.95 0.00 5 21.1
(37.87) (1.19) T
'-• ERTY: 1131: 5•n112 :A••ING 41-2 JSNK •CSLINTY' WEL• ST•TE: C•
)4/12 204 RI 1,114.31 1.991 1.185 2,218.67 0.00 2,218.67 0.03125000 69.34 0.00 S 69.:
34/12 400 RI 3,946.31 0.644 2,542.22 0.00 2,542.22 0.03125000 79.45 0.00 S 79.4
--••E TY'. 1131: ST 1111 =A••ING 3:-2 N=-G C+UNTV' WEU STATE: C•
)4/12 300 RI 95.52 102.732 9,813.04 0.00 9,307.12 0.03125000 306.66 0.00 5 290.E
(505.92) (15.81) T
'R•'E-TY'. 1131:-5711012 1A••ING 3'-26N:-C• C•UNTY: WEL•
ST•T1. C•
14/12 204 RI 25.89 1.990 1.185 51.52 0.00 51.52 0.03125000 1.61 0.00 S 11
14/12 400 RI 91.71 0.646 59.20 0.00 59.20 0.03125000 1.85 0.00 S 1.E
)4/12 300 RI 0.94 102.734 96.57 0.00 91.60 0.03125000 3.02 0.00 S 2.E
(4.97) (0.15) T
'-•'E TV: 1131: 5:11112 . R9 .JSN• C•UNTY: WEU
STATE C•
14/12 204 RI 2,549.12 1.992 1.185 5,076.48 0,00 5,076.48 0.03125000 158.64 0.00 S 1588
14/12 400 RI 9,028.00 0.644 5,816.00 0.00 5,816.00 0.03125000 181.75 0.00 S 181.7
'-•'E TY'. 1131::391101 -IVE•=EN•22-1:JSN• C•UNTV: WEU
STATE'. C•
14/12 300 RI 31.80 102.733 3,266.91 0.00 3,036.90 0.00001874 0.06 0.00 S 0.0
(57.38) 0.00 O
(168.43) 0.00 T
(4.20) 0.00 X
"•'ERTY: 1131: 4211111 MILKY WAV 3-11 JSN• C•UNTV' WEU ST•TE C•
14/12 300 RI 10.03 102.733 1,030.42 0.00 977.30 0.00072063 0.74 0.00 S 0.7
(53.12) (0.04) T
R••ERTY: •13211.11 u13 C•VLE 13-1:AC•• C•UNTY: WEL• STATE' C•
4/12 204 RI 118.82 1.797 1071 213.50 0.00 213.50 0.01798594 3.84 0.00 S 3.9
14/12 400 RI 420.72 0.644 270.77 0.00 270.77 0.01798594 4.87 0.00 S 4.8
14/12 300 RI 84.87 102.732 8.718.94 0.00 8,269.43 0.00390859 34.08 0.00 S 323
(449.51) (1.76) T
'-• ERTV: •032•':: 2 •AC•N• STATE3:3 N:-G C•UNTY: WEL• ST•TE: C•
14/12 204 RI 598.83 1.911 1.174 1,144.20 0.00 1,144.20 0.00390859 4.47 0.00 S 44
14/12 400 RI 2,836.98 0.524 1,486.39 0.00 1,486.39 0.00390859 5.80 0.00 S 58
1
4/12 300 RI 4.69 102.733 481.82 0.00 450.98 0.00018624 0.09 0.00 S 00
(24.84) 0.00 T
1
4/12 300 RI 253.17 102.732 26,008.89 0.00 24,66798 0.12500000 3,251.11 000 S 3,0835
(1,340.91) (167.61) T
I
4/12 204 RI 1,096.44 1.991 1.185 2,183.44 0.00 2,183.44 0.12500000 272.93 0.00 5 272.9
4/12 400 RI 3,883.15 0.644 2,501.68 0.00 2,501.68 0.12500000 312.71 0.00 S 312.7
ELD STATE: CO
4/12 300 RI 1,081.08 102.732 111,062.48 0.00 105,33661 0.12500000 13,882.81 0.00 S 13,167.0
(5,725.87) (715.73) T
R•-E-TY: ••32161 2 :A••ING 1•-2 .-C• C•UNTY: WEL• STATE' C•
4/12 204 RI 915.18 1 091 1.185 1822.48 0.00 1,822.48 0.12500000 227.81 000 S 227.8
4/12 400 RI 3,241.23 0.644 2,088.08 0.00 2,088.08 0.12500000 261.01 0.00 S 261.0
R•-ERTV: ••321 1411111 =AS•ING 15-2 NI-C• O•UNTY: WEL• STATE: C•
4/12 300 RI 202.79 102.732 20,833.20 0.00 19,759.13 0.12500000 2,604.15 0.00 S 2,469.8'
(1,074.07) (134.26) T
-• E-TV: 11321 14•••12 :A••ING 15-2 N=-C• C•UNTV: WEU
STATE C•
4/12 204 RI 1,012.51 1.991 1.185 2,016.32 0.00 2,016.32 0.12500000 252.04 0.00 S 2520.
4/12 400 RI 3,585.91 0.644 2,310.16 0.00 2,310.16 0.12500000 288.77 0.00 S 288.1
00107 CKA 001 005 L1412 - U21L4JS2Jl NNNNNNNNNNNN
0211435237
KERR-MCGEE OIL&GAS ONSHORE LP Page: 6
Owner Number: 374714
Check Date: 06/25/12
Check Number: 0211435237
Check Amount: $51,422.67
WELD COUNTY BOARD OF COMMISSIONER
PR
PROD PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER ADJ OWNER
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS! NET DECIMAL GROSS ADJUSTMENTS CODE NET
VALUE TAXES VALUE INTEREST VALUE /TAXES VALUE
04/12 300 RI 201.31 102.732 20,681.16 0.00 19,614.93 0.12500000 2,585.14 0.00 S 2,451
(1,066.23) (133.28) T
-• E TV: 1.321 151u12 :A••ING1 -2 N:-C• C•UNTY: WEL• C.
04/12 204 RI 1,146.44 1.991 1.185 2,283.04 0.00 2,283.04 0.12500000 285.38 0.00 S 285
04/12 400 RI 4,060.24 0.644 2,615.76 0.00 2,615.76 0.12500000 326.97 0.00 S 326
•-• E-TV: 1132161 11111 :A••ING 21-2 N: . C•UNTY'. WEL• STATE'. C•
04/12 300 RI 215.09 102.732 22,096.82 0.00 20,957.61 0.12500000 2,762.10 0.00 S 2,619
(1,139.21) (142.40) T
-••E-TV: 11321 1611112 :A••ING 21-26 N:-C• UUNTV: WEL• STATE: C•
04/12 204 RI 1,343.76 1.991 1.185 2,676.00 0.00 2,676.00 0.12500000 334.50 0.00 S 334
04/12 400 RI 4,759.08 0.644 3,065.92 0.00 3,065.92 0.12500000 383.24 O00 S 383
-• E-TV: 1132161 11111 :A••ING 24-26 N:-C• •C•UNTY'. WEL• STATE: C•
04/12 300 RI 197.93 102.732 20,333.92 0.00 19,285.59 0.06250000 1,270.87 0.00 S 1,205
(1,048.33) (65.52) T
04/12 204 RI 1,010.72 1.992 1.185 2,012.80 0.00 2,012.80 0.06250000 125.80 0.00 S 125
04/12 400 RI 3,579.58 0.644 2,306.08 0.00 2,306.08 0.06250000 144.13 0.00 S 144
--• ERTV: 11321.2 1 :A••ING 39-26 N:-C• C•UNTV: WEL• STATE: C•
04/12 300 RI 124.37 102.732 12,776.88 0.00 12,118.16 0.06250000 798.56 0.00 S 757
(658.72) (41.17) T
--•-E-TV: 11321.2 3 :A••ING3 -2 N:-C• GUNTV: WEL• STATE: C•
04/12 204 RI 804.46 1.992 1.185 1,602.08 0.00 1,602.08 0.06250000 100.13 0.00 S 10C
04/12 400 RI 2,849.12 0.644 1,835.52 0.00 1,835.52 0.06250000 114.72 0.00 S 114
04/12 300 RI 132.39 102.732 13,600.81 0.00 12,899.61 0.03125000 425.02 0.00 S 403
(701.20) (21 91) T
04/12 204 RI 721.44 1.992 1.185 1,436.80 0.00 1,436.80 0.03125000 44.90 '0.00 S 44
04/12 400 RI 2,555.04 0.644 1,646.08 0.00 1646.08 0.03125000 51.44 0.00 S 51
•-••ERTV' 11321 2311111 :•••ING 1-2 JSN• C•UNTV: WEU STATE: C.
04/12 300 RI 7.08 102.731 727.34 0.00 689.84 0.06250000 45.46 0.00 S 43
(37.50) (2.35) T
-R•'E TV: 11321.2311112 :A••ING 1-2.JSN• •C•UNTV: WEL• STATE'. C•
04/12 204 RI 557.15 1.991 1.185 1,109.44 0.00 1,109.44 0.06250000 69.34 0.00 S 65
04/12 400 RI 1,973.20 0.644 1,271.20 0.00 1,271.20 0.06250000 79.45 0.00 S 75
-•PERTV: 11321 35nn1 :A••ING 2-2• JSN• C•UNTY'. WEL• STATE: C•
04/12 300 RI 20.10 102.733 2,064.94 0.00 1,958.48 0.06250000 129.06 0.00 S 12
(106.46) (6.65) T
04/12 204 RI 1,441.09 1.991 1.185 2,869.76 0.00 2,869.76 0.06250000 179.36 0.00 S 171
04/12 400 RI 5,103.74 0.644 3,288.00 0.00 3,288.00 0.06250000 205.50 0.00 S 20`t
•-••E-TY' 1132214 1 RIVE :EN•12-1:JSN• C•UNTY: WEL• STATE: C•
04/12 300 RI 77.72 102.732 7,984.40 0.00 7,422.24 0.00001874 0.15 0.00 S
(140.25) 0.00 G
(411.64) (0.01) T
(10.27) 0.00 X
04/12 300 RI 113.42 102.732 11,651.97 O00 11,051.25 0.06250000 728.25 0.00 S 691
(600.72) (37.54) T
04/12 300 RI 10.93 102.732 1,122.87 0.00 1,064.97 0.06250000 70.18 0.00 S 61
(57.90) t Oi Ta&L/4
0211435237
Page. 7
'ROD PROD INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER ADJ OWNER
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS! NET DECIMAL GROSS ADJUSTMENTS CODE NET
VALUE TAXES VALUE INTEREST VALUE /TAXES VALUE
"• E'TV: .13222. ..112 :A••ING 11-2. JSN• C•UNTY: WEL• ST•TE'. C•
04/12 204 RI 297 33 1.992 1.185 592.16 0.00 592.16 0.06250000 37.01 0.00 S 371
04/12 400 RI 1,053 01 0.644 678.40 0,00 678.40 0.06250000 42.40 0 00 S 42.
'-•-E'TY'. •.322217 L1••1 :A••ING 15-2 JSN• C•UNTV: WEL• - ST•TE: C•
04/12 300 RI 15.12 102.732 1,553.32 0.00 1,473.23 0.06250000 97.08 0.00 S 921
(80.09) (5.01) T
P
04/12 204 RI 1,925.90 1.991 1.185 3,835.20 0.00 3,835.20 0.06250000 239.70 0.00 S 239.
04/12 400 RI 6,820.82 0.644 4,394.24 0.00 4,394.24 0.06250000 274.64 0.00 S 274.i
R••ERTY'. 0132221 .11.1 :A••ING 16-2. JSN• C•UNTY: WEL• STATE: C• -,
04/12 300 RI 13.00 102.733 1,335.54 0.00 1,266.69 0.06250000 83.47 0.00 S 79.
(68.85) (4.31) T
•-•'ERTY. 1.3222.: 2 :.•SING 1 -2. JSN• C•UNTY: WEL! STATE: C•
04/12 204 RI 1,820.54 1.991 1.185 3,625.44 0.00 3,625.44 0.06250000 226.59 0,00 S 226.1
04/12 400 RI 6,447.68 0.644 4,153.76 0.00 4,153.76 0.06250000 259.61 0.00 S 2591
7-
04/12 300 RI 7.72 102.733 793.10 0.00 752.21 0.06250000 49.57 0.00 S 471
(40.89) (2.56) T
•-••E-TV: .1322213.1n2 :A••ING -2 C•UNTY'. WEL• STATE: C•
04/12 204 RI 1,044.66 1.991 1.185 2,080.32 0.00 2,080.32 0.06250000 130.02 0.00 S 1301
04/12 400 RI 3,699.74 0.644 2,383.52 0.00 2,383 52 0 06250000 148.97 000 S 148'1
•-•-E'TV: It WI :•fING :-2 JSN• C•UNTY: WEL• STATE: C•
04/12 300 RI 9.76 102.732 1,00267 0.00 950.98 0.06250000 62.67 0.00 S 59
(51.69) (3.23) T
.13222151''.2 SA••ING :-2 JSN• C•UNTY: WEL• STATE'. C•
04/12 204 RI 1,153.58 1.991 1.185 2297.28 0.00 2,29728 0.06250000 143.58 0.00 S 143.
04/12 400 RI 4,085.54 0.644 2,632.00 0.00 2,632 00 0.06250000 164.50 0.00 S 164.
• E-TY: a 322334 n 1 'IVE':EN• 23-1 N:- • C•UNTV: WEL• STATE'. C•
04/12 300 RI 428 26 102.732 43,996.39 0.00 40,898.76 0.00084555 37.20 0.00 S 34.
(772.81) (0.55) G
0.00 (0.35) I
(2,268.25) (1.92) T
(56.57) (0.05) X
•-• E-TV' .132741: 1 MA'KHAM 35-: N:-C• C-•LINTY: WEL• STATE: C•
04/12 300 RI 1,062.74 102.732 109,176.36 0.00 103,549.62 0.06250000 6,823.65 0.00 $ 6,471.
(5,628 74) (351.80) T
•••E'TY'. .•32742211111 MA'KH•M 34-: N:-C• C•UNTY: WEL• ST•TE: C•
04/12 300 RI 780.67 102.732 80,200.49 0.00 76,065.72 0.03125000 2,506.26 0.00 S 2,377.
(4,134.77) (129.21) T
-•••ERTY: .132742311111 MA-KHAM 34-: JSN• C•UNTY' WEL• STATE'. C•
04/12 300 RI 789 102.732 810.56 0.00 768.77 003125000 25.33 0.00 5 24.
(41.79) (1.31) T
'• E-TV: II 3274311.111 MA-KHAM35-•JSN• C•UNTY'. WEL' STATE: C•
04/12 300 RI 10.73 102.733 1,102.33 0.00 1,045.50 0.06250000 68.90 0.00 S 65.
(56.83) (3.55) T
-••E-TY: •132777 n''11N•UYE 15-31A N:-C• C•UNTY' WEL• STATE: C•
04/12 300 RI 460.34 102 732 47,292.06 0.00 44,853.90 002756234 1,303.48 0.00 S 1,236.
(2,438.16) (67.20) T
04/12 300 R! 451.34 102.732 46,367.47 0.00 43 976.97 0.00878906 407.53 0.00 S 386.
(2,390.50) (21.01) T
04/12 300 RI 311.12 102732 31,962.26 000 30,314.43 0.03125000 996.82 0.00 S 947.
(1,647.83) (51.49) T
04/12 300 RI 7.34 102.733 754.06 0.00 715.18 0.00439453 3.31 0.00 5 3.
(38.88) (0.17) T
'R•'E-TV'. 1.327:791.111 HU'C•3 -1: JSN• C•UNTY: WEL• ST•TE'. C•
04/12 300 RI 4.55 102.731 467.43 0.00 443.33 0.00078906 4.11 0.00 S 3
(24.10) (0.21) T
PR•-E-TV: •.327: 1 HS--KUNZMAN FE•E-AL1 -•• N:-C C•UNTY: WEL• STATE'. C•
04/12 300 RI 209.89 102.732 21562 61 0.00 20,044.47 0 00142812 30 79 0.00 S 28.
(378 75) (0.54) G
C•UNTY:(1,111 67) (1.59) T
(27.72) (0.04) X
'• E'TY: .1327 nni CA-TE- 23-32 N:-C• WEL• STATE' C•
04/12 300 RI 336.38 102.732 34,557.30 0 00 32,775 69 0 00227000 78 45 0.00 S 74
(1,78161) (4.04) T
- STATE: CO
04/12 300 RI 136.06 102.732 13,977.84 0.00 13,257.21 0 00115434 16.14 0 00 S 15.
(720.63) (0.83) T
-• E'TY. n32' 1 CA'TE- 3•-32 JSN• C•UNTY: WEL• ST•TE: C.
04/12 300 RI 20 15 102.733 2,070.08 0.00 1,963.36 0.00115434 2.39 0.00 S 2
(106.72) (0.12) T
R• -E-TV'. 1.32-•11.•1.1 CA-TE- 23-32JSN• C•UNTY: WEL• STATE: C•
04/12 300 RI 84.41 102.733 8,671.69 0.00 8224.62 000227000 19.68 0.00 S 18
00107 ([A 001 005 17412 - D211435e3+ NNNNNNNNNNNN
0211435237
KERR-MCGEE OIL&GAS ONSHORE LP - Page. 8
Owner Number: 374714
Check Date: 06/25/12
Check Number: 0211435237
Check Amount: $51,422.67
WELD COUNTY BOARD OF COMMISSIONER
---
PROD PROD' INT PROPERTY PROPERTY PROPERTY PROPERTY OWNER OWNER OWNER ADJ OWNEI
DATE CODE TYPE QUANTITY PRICE BTU GROSS ADJUSTMENTS, NET DECIMAL GROSS ADJUSTMENTS CODE NET
VALUE TAXES VALUE INTEREST VALUE /TAXES 1 VALUE
TOTALS 52,699.81 51,42:
DEPARTMENT OF FINANCE
AND ADMINISTRATION
1861 - 2011 PHONE (970) 356-4000, Ext. 4218
FAX: (970) 352-0242
P. O. BOX 758
-r' GREELEY, COLORADO 80632
WELD-COUNTY
March 20, 2012
KERR MCGEE OIL & GAS ONSHORE LP
1201 LAKE ROBBINS DR
THE WOODLANDS TX 77380
RE: Withholding Taxes
Enclosed please find IRS Form 6458 for Weld County. Weld County, as a county government,
is tax exempt from ad valorem, severance, and windfall profit taxes. You are withholding taxes
on the attached leases. Please correct your records so taxes are not withheld in the future.
Also, please refund the taxes withheld and send to Clerk to the Board, Weld County
Government, Attn: Tonya Disney, P. O. Box 758, Greeley, Colorado, 80632.
Very truly yours,
SI
Tonya Disney (�
Deputy Clerk to the Board
Weld County
Enclosures: 6458 Forms
— CW1/4-9 Artm ‘S...tnr Gkt, c331�- I"'Z StG cn,, -Eta Qnkm}3v, K J4S
@
C\ •
Form 6458
(Rev.June 1985) - Certification and Election Form OMB No.1545-0230
Department of the Treasury ► See separate Instructions. Expires 430.88
Internal Revenue Service
Name Taxpayer identifying number
Weld County, Colorado, Board of County Commissioners 84-6000813
Address(number and street) .
915 10th Street, P.O. Box 758
City or town,state and ZIP code
Greeley, CO 80632
Name of purchaser(only completed by a purchaser who is forwarding a qualified disburser election) Taxpayer Identifying number
Part I Exemption Certificate
I certify that all my production from the properties on the attached list is exempt from the windfall profit tax.
I am entitled to this exemption because I qualify for the status indicated below(check applicable box):
Qualified governmental interest(section 4994(a)) 0 Exempt Indian oil(section 4994(d))
❑ Qualified charitable interest(section 4994(b)) 0 Qualified independent producer of exempt stripper well oil(section
4994(g))
I understand that I must file Part III within 10 days after I no longer qualify for exemption from the windfall profit tax.
Under penalties of perjury. I declare that I have examined this certificate, including accompanying instructions, and to the best of my knowledge and
belief,it is true,correct,and complete.
CHAIRMAN, BOARD OF COMMISSIONERS
Signature of exempt producer ► Cr.P Date ►
Part II Independent Producer Certificate
I certify that I qualify as an independent producer as defined in section 4992, and that all my taxable production from the properties
listed on the attached sheet is entitled to the lower rate of windfall profit tax fortier one and tier two oil.
The total taxable production from these properties (plus production from other qualified properties that I have certified)does not
exceed my share of the 1,000 barrel a day amount for independent producers.
I certify that(check applicable box):
❑ I am a member of a related group(as defined in section 4992(eX2)). I am attaching a list to the Form 6458 that I am filing with the
IRS showing the name and taxpayer identifying number of all other members of my"related group."
❑ I am not a member of a related group(as defined in section 4992(eX2)).
I understand that I must file Part III within 10 days after I no longer qualify as an independent producer.
Under penalties of perjury, I declare that I have examined this certificate, including accompanying instructions, and to the best of my knowledge and
belief.it is true,correct.and complete.
Signature of independent producer ► Date ►
Part III Revocation of a Previously Filed Certificate
I no longer qualify for exemption from,or reduced rates of,the windfall profit tax.The status that I previously claimed was:
❑ Qualified governmental interest ❑ Independent producer 0 Qualified independent producer of exempt stripper well oil
❑ Qualified charitable interest ❑ Exempt Indian oil
Date of original certification ► Service Center where filed ►
Effective date of revocation D.
Signature of producer ► Date ►
Part IV Qualified Disburser Election
I certify that I am a qualified disburser as defined in regulations section 51.4995.5(b)and that I hereby elect to perform all the duties norma9y imposed
upon the purchaser in regard to the administration of the windfall profit tax.
I understand that I must file Part VI within 10 days after this election is terminated. •
Effective date of election -
Property(include full lease name.location,and identifying number,it applicable)
•
Signature of qualified disburser Date
For Paperwork Reduction Act Notice,see page 1 of the Instructions. Form 6458 (Rev.6-851
DR 0021W
11/22/10) WEB
COLORADO I DEPARTMENT OF REVENUE OIL AND GAS WITHHOLDING STATEMENT
DENVER CO 80261-0007 �t'1t (`(� �/ FOR CALENDAR YEAR 2011
Colorado S'e Ar.L ccQ iithheld from Oil Shale and Oil/Gas Payments
+ .
1. Well Name y I :,�Ic,r>lf11"}r 4. County
2. Lease 2017 FEB 21 A 10: 59 5. American Petroleum
Institute Well Number
3. Field ,( p SEE REVERSE SIDE FOR INSTRUCTIONS
+l C C 1 Y+,/ C D CASH BASIS ACCRUAL BASIS
6. GROSS INCOME - $ 266,305.05 $ 322,544.38
7. GROSS INCOME ATTRIBUTABLE TO STRIPPER $ $
WELL PRODUCTION
8. AD VALOREM TAX ON OIL AND GAS $ $
PRODUCTION
9. AD VALOREM TAX ATTRIBUTABLE TO $ $
STRIPPER WELL PRODUCTION
10. SEVERANCE TAX WITHHELD • $ 1,061.35
If filing on a fiscal period, this information is not correct. Consult your distribution statements or payor for correct amounts.
11. Name,Address and Social Security or Colorado Account No.of Payee: •12. Name,Address and Colorado Account No.or Federal I.D. of Payor:
WELD COUNTY BOARD OF COMMISSIONER Kerr-McGee Oil& Gas Onshore LP
PO BOX 758 1201 Lake Robbins Dr.
GREELEY.CO 80632 The Woodlands.TX 77380
84-6000813 RV37471404 84-1175723
NOTE TO PAYOR: Attach one copy to the OR 0456. Retain a copy for your
records.Submit two copies to payee.
CUT HERE
DR 11/22/10) WEB
COLORAiDO DEPARTMENT OF REVENUE OIL AND GAS WITHHOLDING STATEMENT
DENVER CO 80261-0007 FOR CALENDAR YEAR 201!
Colorado Severance Tax Withheld from Oil Shale and Oil/Gas Payments
1. Well Name 4. County
2. Lease 5. American Petroleum
Institute Well Number
3. Field SEE REVERSE SIDE FOR INSTRUCTIONS
CASH BASIS ACCRUAL BASIS
6. GROSS INCOME $ 266,305.05 $ 322,544.38
7. GROSS INCOME ATTRIBUTABLE TO STRIPPER
WELL PRODUCTION
8. AD VALOREM TAX ON OIL AND GAS $ $
PRODUCTION
9. AD VALOREM TAX ATTRIBUTABLE TO $ $
STRIPPER WELL PRODUCTION
10. SEVERANCE TAX WITHHELD • $ 1,061.35
If filing on a fiscal period, this information is not correct. Consult your distribution statements or payor for correct amounts.
11. Name,Address and Social Security or Colorado Account No.of Payee: •12. Name,Address and Colorado Account No.or Federal I.D.of Payor:
WELD COUNTY BOARD OF COMMISSIONER Kerr-McGee Oil&Gas Onshore LP
PO BOX 758 1201 Lake Robbins Dr.
GREELEY.CO 80632 The Woodlands.TX 77380
84-6000813 RV37471404 84-1175723
NOTE TO PAVOR: Attach one copy to the DR 0456. Retain a copy for your
records.Submit two copies to payee.
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