HomeMy WebLinkAbout20112436 NADOA Model i-„i to Division Order(Adopted 9/95)
DIVISION ORDER
To: Weld County Clerk of the Board of Date: August 30, 2011
Land Commissioners
Property Number: Effective Date: 15t date of production
Property Name: See Exhibit"A" Lease No.:
Operator: Bonanza Creek Energy Inc.
County and State: Weld County,CO
Property Description: See Exhibit"A"
Production: Oil X Gas Other:
Owner Name Weld County Clerk of the Board of Land OWNER NUMBER: 1041
And Address: Commissioners
P O BOX 758 Type of Interest: See Exhibit"A"
GREELEY,CO 80632-0758 Decimal Interest: See Exhibit"A"
The undersigned certifies the ownership of their ownership of their decimal interest in production or proceeds as described above
payable by Bonanza Creek Energy Inc. (Payor).
(Company Name)
Payor shall be notified,in writing, of any change in ownership,decimal interest, or payment address. As 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 One Hundred Dollars ,or pay N/A 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:
Weld County Clerk of the Board of Land Commissioners
o . /
Owner(s)Signature(s): \ + 1
7TLi�l L u ! :ALL-,. 2;1.-- Attest:
arbara KirSeye , Chair r1P 1 4 2011 Cierk Ito the Bo rd
Owner(s)Tax I.D.Number(s) 84-6000-813 By: /an
Deputy Cler o the Board
Owner Daytime Telephone#: 970-356-4000 X4200
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Owner Fax Telephone#: 970-352-0242
1861 O.
Federal Law requires you to furnish your Social Security of Taxpayer Ident3 'i
Failure to corn will result in 31% tax withholdin and will not be refun'- V 'le <
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NO*. Plait 3 -31-1
�p� D5'�� 3' 33�1 j at.. 'i 06 aMCU-114 t* 201 1-2436
Exhibit "A"
Attached to Division Order dated 8-30-11
Weld County Clerk of the Board of Land Commissioners
Well Name Interest Type Decimal Interest Legal Description
NORTH PLATTE 32-34 RI 0.20000000 SW/4 NE/4 OF SEC. 34,T5N, R63W
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.
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BY: )<7P-'
A Couar fy Attomey
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/DATE: `� — 7 —
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