HomeMy WebLinkAbout20120839.tiff KERR-MCGEE OIL AN GAS ONSHORE DIVISION ORDER
Venture Number: 320918
Property Number: 3031678
WELD COUNTY( Property Name: CENTEX 40-25 JSND
WELD COUNTY BOARD OFf�t fj'A m c I Ti R S Product: All Products
�V` Status: NOT APPLICABLE
1011 FEB 21 A II: 03 County/State: WELD/CO
PO Box:758 Effective Date: DATES OF FIRST SALES
'
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER
GREELEY,CO 80632 RECEIVED Interest Amt/Type: 0.00018624/RI
Unit Description:
T2N-R68W,Sec 25:SE/4NE/4,NE/4SE/4&T2N-R67W Sec 30:
SW/4NW/4,NW/4SW/4 COVERING 156.4866 ACRES,M/L
OF THE 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#
Attest: c.-----,
C1e k to the Boa Owner Signature/ o t ' e Owner Address(if different from above)
B �l�. .(vfleri Sean P. Conw.. , h
Deputy I
e Board Owner Signature/Corporate Titl City,State Zip Code
1•y ;. I_= -) ` 970-356-4000
MAR 2 6 2012 Owner Daytime Phone
ISb11‘ W
Vtft A7
*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 ceeo-0g34
Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: February 22,2012 Q ��
P.O.Box 173779 - {4,. Prepared by: KP
_06/0/0? Denver,CO 80217-3779 C O CIS) 2-1-12- Susp: Y L t O Q-30 "
1-800-677-5603 J 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 i ble.
BY:
Cou Attomey
DATE: —��, )-0 J )
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