HomeMy WebLinkAbout20110024.tiff NADOA Model Form Division Order(Adopted 9/95)
DIVISION ORDER
To: Weld County Board of Date: December 7, 2010
Commissioners
Property Number: Effective Date: 1st date of producti6rrf ^••' e �' n
Property Name: See Exhibit"A" Lease No.:
Operator: Bonanza Creek Energy Operating Company,LLC
County and State: _Property Description: 1p/ 05- 1.W 3- , 377
Production: Oil AP/
Gas Other:
Owner Name Weld County Board of Commissioners OWNER NUMBER: 1041
And Address: P O Box 758
Greeley,CO 80632-0758 Type of Interest: See Exhibit"A"
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 Operating Company,LLC (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:
Wel County oard of Commissioners
Owner(s)Signature(s): //
I,( Q, tfi{/ /A - Barbara Kirkmeyer. Chair
JAN 0 3 2011
Owner(s)Tax I.D.D.Number(s)
84-6000-813
Owner Daytime Telephone#: 970-356-4000 X4200 Attest:
Clerk to he Board
Owner Fax Telephone#: 970-352-0242 Bye/ if yjpa
Deputy Cler tb t B
,fit
Federal Law requires you to furnish your Social Security of Taxpayer Identification Numbe
Failure to comply will result in 31% tax withholding and will not be refundable by Payor.
14Y
2011-0024
LEO l
Exhibit"A"
Attached to Division Order dated 12-7-10
Weld County Clerk of the Board of Land Commissioners
Well Name Interest Type Decimal Interest
®'k,PRONGHORN 12-9 RI jg o 13 0.125 5u '1 n\t.>1 S') Ts r' k •, to
61L PRONGHORN 14-4 RI / .9)(9) ;- 0.0625 s _'1 T ro .4,,.‘ .i
LPRONGHORN 43-15 RI 0.125
Ok, WELD COUNTY 22-15 RI 0.125 3E4 wwu s!s r) kbFw
OK PRONGHORN 34-22 RI 1_t,alh 0.125 swy5E'a. as "5Nk!a�al
DIC PRONGHORN 31-21 RI LEoai5 0.125 ro N ' '''"'"`'
-v NORTH PLATTE 31-34 RI LE0/73 0.2 N"�4Nf" 5=-+ +5r? ' '
Lc NORTH PLATTE 41-34 RI LEDI7J 0.2 S34 tn :,
•
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 torn, legal description, and
percentage of royalties, if applicable.
1% AtoY
DATE: /2 2Z ��
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