HomeMy WebLinkAbout20111451 NADOA Model Form Division Order(Adopted 9/95)
DIVISION ORDER
To: Petroleum Development Corporation Date: June 6,2011 C •R
1775 Sherman Street,Suite 3000
Denver,CO 80203
Attn: Terah Coffman (303) 860-5805
Property Number: 105.100010 Effective Date: February 18, 2011
Property Name: Chesnut 22OD NBCD
Operator: Petroleum Development Corp
County and State: Weld, Colorado
Property Township 5 North,Ranee 64 West
Description: Section 22: NESW(spacing SWNE,SENW, NESW,NWSE)
Production: X Oil X Gas X Other: all products
Owner Name OWNER NUMBER: 43444
and Address:
Weld County Brd Of Comm Type of Interest: RI
PO Box 758 Decimal Interest: 0.00141973
Greeley,CO 80632-0000
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Petroleum
Development Corporation(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$50.00,or pay yearly 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.
Special Clauses: None/or See Art shed Exhibit)
Owner(s)Signature(s): IA}V/ 1 � it_. Barbara Kirkmeyer, Chair
Weld County Btl Of Comn}� JUN 1 3 2011
Owner(s)Tax ID(EIN or SSN): 84-6000-813
Owner Telephone(optional):
Owner Email (optional):
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 28 %tax withholding and will not be refundable by Payor
TOC
Retain this copy for your records
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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:
Coun Attomey
DATE:
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