HomeMy WebLinkAbout20120334.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 328001
WELD COUNTY Property Number: 1096944
COMMISSIONERS Property Name: CARTER 23-32 JSND
Product: All Products
WELD COUIYj�BQQrR,g1OF COIONER Status: NOT APPLICABLE
((tl Jd11�W LL�O H County/State: WELD/CO
PO Box: 758 Effective Date: DATES OF FIRST SALES
RECEIVED Owner Number: RV3747 1404-WELD COUNTY BOARD OF COMMISSIONER
GREELEY,CO 80632 Interest Amt/Type: 0.00227000/RI
Unit Description:
T2N-R66W,Sec 32:E/2SW/4&W/2SE/4
160 ACRES,M/L
J-SAND FORMATION
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#
i )
Attest:
Cl rk to th Boa Owne ignature/ orporate Title Owner Address(if different from above)
By: William F. Garcia, Chair Pro—Tern
Deputy Cler oard Owner Signature/Corporate Title City,State Zip Code
g j[,a FEB 012012
Owner Daytime Phone
1861 a
Fir
t s,
*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
I Et)I�
Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: January 19,2012
P.O.Box 173779 16,, r -Mc.( v (Levu. ) Prepared by: KP D/ate egg9
Denver,CO 80217-3779 11 Susp: N
1-800-677-5603 - a- I 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 applicable.
,BY: �'','2/i'� 4A-mss
j/County Attorney
DATE: /-2L "L
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