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HomeMy WebLinkAbout20122385.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER Venture Number: 318710 Property Number: 1093247 Property Name: BADDING 20-26SX SUSX 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. 12500000 / RI Unit Description: T2N-R66W, Sec 26: SE/4 COVERING 160 ACRES, M/L OF THE SUSSEX 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 gm. 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 272012 VVELD COUNTY COMMISSIONERS RV37471404 WELD COUNTY BOARD OF COMMISSIONER *Tax ID # XXX-XX-0813 * *Tax ID # Attest : • 12i- 91er to the , and 2 Owner Signature/Corporate Title Z U 5 2012 Owner Address (if different from above) /BY Sean P . Conwa Chair Deputy C d Owner Signature/Corporate Title City, State Zip Code 970-356-4000 ;V `U �y� Owner Daytime Phone tb61 7�rI �.�r 1 / C*y •,,. et/writ et/writ af4eAC/VE) V 51mo'er /2 2012-2385 * Failure to furnish your Social SecuriAITax ID number will result in withholding tax in accordance with federal law and any tax withheld win not oe iewnuamn or Nzyw . * *Insert Tax ID number for all individual parties listed above in the Name and Address box L5 9 Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: August 23, 2012 P.O. Box 173779 et/ AJL 6L yvh GC1 e c Prepared by KP Denver, CO ssc : 7-3779 (p21 U) Susp: N 61 ' 1 -11- I -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. -7-414 .�,r ` Co my Attorney DATE: 12- 2112 Hello