HomeMy WebLinkAbout20112859.tiff KERR-MCGEE OIL AN 3AS ONSHORE DIVISION ORDER
Venture Number: 320919
Property Number: 3031679
Property Name: CENTEX 24-25 JSND
Product: All Products
WELD COUNTY COLORADO Status: NOT APPLICABLE
C/O BOARD OF COUNTY COMMIS County/State: WELD/CO
915 10TH STREET Effective Date: DATES OF FIRST SALES
Owner Number: RV37471504-WELD COUNTY COLORADO
GREELEY,CO 80631 Interest Amt/Type: 0.00040355/RI
Unit Description:
T2N-R68W,Sec 25:E/2 COVERING 320.00 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 COLORADO *Tax ID#XXX-XX-0813
C/O BOARD OF COUNTY COMMIS **Tax ID#Attest i - //X—
to
t h' :oar er Signa � .'r. Title Owner Address(if different from above)
By/� j/�/ 1�� � � Bar. .r.. YZ}i kmeyer, Chair
Deputy Cl- � � l•and Owner Sly,.• e/ orporate Title City,State Zip Code
CC 2 C 2 II
_1 Owner Daytime Phone
1861 t, C �r
•
*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
LE.--0 ,3D—
Return to: KERR-MCGEE OIL AND GAS ONSHORE \ Date Prepared: October 14,2011
P.O.Box 173779 C C '. Y Lc V.'Q ) Prepared by: Katie Petross p,
Denver,CO 80217-3779 _ a s-I / 0201/,-- $a 59-
1-800-677-5603
•
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.
ABY:
/� Ad y`'
/JLVCoun Attorney
DATE:
Hello