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Home My WebLink About20122133.tiff l?C' .,..-... $--. KERR-MCGEE OIL AN GAS ONSHORE DIVISION ORDER Venture Number: 329836 f47j 05-m 3 3_ )09 a WELD coUNT'Property Number: 1111918 l l j M M l 3 5 l Q N E RSoperty Name: SANDLIN-WELD COUNTY 2 NB-CD Product: All Products WELD COUNTY BOARD OF CON )LS IQNEIbl, A U U St3 s: NOT APPLICABLE �\ ((��(( �tt77 ZV County/State: WELD/CO PO Box:758 Effective Date: DATES OF FIRST SALES RECEIVEDwner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER GREELEY,CO 80632 Interest Amt/Type: 0.12500000/RI =cs>Ki�iee� 617\1,Sec 17:E/2NW/4 kOVERING 80 ACRES,M/L OF THE NIOBRARA CODELL 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) RV37471404 WELD COUNTY BOARD OF COMMISSIONER *Tax ID#XXX-XX-0813 **Tax ID# =--,-- p ._-____3 Attest. Cler to the Bo_-, d Owner Signature/Corporate Title Owner Address(if different from above) By: ,� �'�~'�*►;: / , Sean P. Conway, Chai Deputy C1S.4r7 .� �... ••,id Owner Signature/Corporate Title City,State Zip Code iir 4,,,,,,v142#41 AUG 1,3 2012 970-356-4000 It Owner Daytime Phone N2U,Jf 14-Y 01 eeltAti411! '6r6412.6U P— /8 / *Failure to furnish your Social Security/Tax ID number will result in withholding tax in accordance with federal law and any tax withheld• **Insert Tax ID number for all individual parties listed above in the Name and Address box 2012-2133 Return to: KERR-MCGEE OIL AND GAS ONSHORE 4MC/!�� Date Prepared: August 03,2012 P.O.Box 173779 14(r I,1 l?7 Prepared by: KP Denver,CO 80217-3779 `F. 13-, a Susp: N 1-800-677-5603 LE V063 3 Anadarko Petroleum Corporation Owner On-Line Access To access your Anadarko Petroleum Corporation and/or it's subsidiaries such as Kerr McGee, Howell, etc royalty check/EFT statements. In addition to viewing and printing your check detail, you will be able to create simple revenue reports, get answers to frequently asked questions, pull copy of your 1099 Misc Tax form and prepare change of address forms on-line via the internet. Go to ... www.uldex.com Scroll down left side of page until you get to"Owner Relations Connect Websites"see below Click on "Anadarko". O*Payaoas O efluogenng •Revenue O eetatmNnts C7 Client Login I I • I owimi nHt l tninxwt immitsIla _ a Simplify the way you manage and analyze revenue production,and cost information '� r a„.. ..A.. T� v a v Otlgea-proven tecnnology to transform the business of energy e&Isinss MCWgence SWAons O enarawr, O eBongeone Oelikevemat O estanvnents Then click on View Documents and Reports ,click here to iogin Log in here and it will prompt you to put in your Login and password. NOTE: If you are a first time user be sure to click on First-time users: click here! . It will then prompt you to put in your Login and Temp Password (see below instructions) a* First time users (Please note a check/EFT must be issued first before an Oildex account is set up. If you have not received a royalty check no information will be posted in oildex.) Please be sure to click on " I am a first time user n then User ID = (Your 6 digit Owner Number. Do not include the RV or 04 at the end, that is for internal use only.) Temp Password = (typically the last six digits of Social Security Number (SSN) or Tax ID Number I (TIN) associated with the account * (or a unique temporary password, see below) I Then it should prompt owner to put in a permanent password, must be at least 6 alphanumeric characters. A confirmation email which will include the password you have chosen will be emailed to you. * (We subscribe to Oildex and they are requested to use the last 6 digits of SSN/ TIN as the Temp password, however, we have found that in some cases if Oildex does not have the SSN/TIN at the time of set up they will choose a unique temp password other than the last six digits of SSN/TIN. In this case the owner may call or e- mail CRM-Revenue©anadarko.com 1-800-359-1692, Option 2. Please note we will require the ra► Owner Number along with the SSN / Tax ID # associated with the account in order to provide you with the Temporary Password.) If you have any other problems accessing www.oildex.com please contact Anadarko Petroleum Corp. at CRM-Revenue@anadarko.com or Oildex support directly at: support(g)oildex.com Check out the new Anadarko Owner Relations Website: Go to www.anadarko.com, click on About Anadarko, then click on Owner Relations. Our new owner relations website provides details in regards to owner issues. This is a helpful tool to utilize for issues about royalty checks, owner interest questions and much more! Dear Interest Owner: 1. Enclosed are two copies of your Division Order or Transfer Order. Please execute the first copy in front of two witnesses and provide a valid Social Security Number or Tax Identification number. The second copy marked "Copy" is for your records. a. Sign exactly as shown on the Division Order or Transfer Order. Signatures must be witnessed by two people. If joint ownership, all owners will be required to sign, but may sign separate copies. Signatures by Agents, Attorneys-in-Fact, Guardians or Trustees must be verified by attaching evidence of the right to sign in that manner, such as a copy of the Power of Attorney. b. Include the correct Social Security Number or Tax Identification Number in the space provided. Failure to furnish this information may result in withholding tax in accordance with federal law and any tax withheld will not be refundable by payor. If the name on the Division Order or Transfer Order does not match the name on your Social Security Card, please advise us, in writing, of the differences. 2. Please address all correspondence, including your executed Division Order, to the following address: Kerr McGee Attn: Division Orders P.O. Box 173779 Denver, CO 80217-3779 3. For CHANGE OF ADDRESS, please submit all changes to the above address. All ADDRESS CHANGES MUST BE MADE IN WRITING. 4. NAME AND OWNERSHIP CHANGES must be submitted in writing to the above address. In order to process the name and ownership changes, we require the following documentation: a. Name Changes: Marriage Certificate, Divorce Decree, etc. b. Ownership Changes: Deeds, Assignments, etc., must be recorded in the County (Parish) in which the property is located prior to sending them to our office. Copy of the document sent in must have evidence of the recording (e.g., the recording stamp) on it. c. Changes due to Death of an Owner: As a general rule, we require complete copies of probate proceedings rendered by a court having jurisdiction over the property in question. If the Estate was not probated, or if it was probated in a different state, other documentation may be required. 5. Anadarko Customer Relations toll-free telephone number: 1-800-359-1692. Our Customer Relations Agents are committed to monitoring and returning calls in a timely manner. Our goal is to return your call within two business days. 6. When you wish to make an inquiry or request a change, please have available as much of the following information as you can: -Owner Number -County and State where well is located -Well name and/or property number -Your telephone number with AREA CODE 7. For access to check history information: htto://www.oildex.com, or refer to the attached instruction sheet. For Technical Questions related to this website please call: 1-888-922-1222 (option 3). 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: �sr�.C /vaces=2— ACo my Attorney DATE: A' Hello