HomeMy WebLinkAbout20111430.tiff d P
Midstream
Division Order
Return to: DCP MIDSTREAM,LP Analyst Initials: TAMMY QUADNAU
6120 S YALE SUITE 1100 Division Order: 216991
TULSA, OK 74136 Date Issued: 5/11/2011
Date Effective 4/1/2011
Well Reference Number:
Meter Number: 216991
Plant: WELD
Property Name: WOLFSON 26-10
Product: ALL ASSOCIATED PRODUCTS
Operator: SYNERGY RESOURCES CORPORATION
County and State: WELD COUNTY, CO
Property Description: NW SE OF SECTION 26, TOWNSHIP 4N,RANGE 67W
SEE ATTACHED EXHIBITA
The undersigned certifies: (i) the ownership of the above percent interest in production or proceeds, and the right to
receive the above percent interest in production or proceeds, or(ii) the right to receive the above percent interest in
production or proceeds, and authorizes DCP MIDSTREAM, LP to distribute such production or proceeds to the
undersigned in accordance therewith.
The undersigned agrees to indemnify and reimburse DCP MIDSTREAM, LP any amount attributable to an interest
erroneously claimed herein by the undersigned.
DCP MIDSTREAM,LP is authorized to withhold payment pending resolution of a title dispute or adverse claim asserted
regarding an interest claimed herein by the undersigned.
DCP MIDSTREAM,LP may accrue proceeds semi-annually or until the total amount accrued equals$100.00,whichever
occurs first, or as required by applicable state statute.
The undersigned, or their authorized representative, shall notify DCP MIDSTREAM, LP in writing of any change in
ownership,percent interest,or payment address. All such changes shall be effective the first day of the month following
receipt of such notice.
This Division Order does not amend any lease or operating agreement, between the undersigned and the lessee or
operator,or any contracts for the purchase of oil or gas.
In addition to the terms and conditions of this Division Order,the undersigned and DCP MIDSTREAM,LP may have
certain statutory rights under the laws of the state in which the property is located.
Other Requirements/Provisions:
Owner(s) /C
Signature(s): (/
LD couN BoaRD JUN 0 E 2011
COMMISSION RS
Title: Chair
Owner No.402852
SSN or Tax ID: 84-6000-813
Remittance Address: 915 10TH ST
GREELEY,CO 80631
Home Phone Number: Work Phone Number: 970-356-4000 X4200
E-Mail Address: FAX Phone Number: 970-352-0242
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 DCP MIDSTREAM,LP
Please be advised this interest will remain in suspense until an executed division order is returned.
COPY
•
02011.-/51-3
LC O153
EXHIBIT "A"
Attached to and made part of that certain DCP MIDSTREAM, LP
DIVISION ORDER,Dated 5/11/2011,
pertaining to the WOLFSON 26-10, Meter#216991, Well Ref. ,
located in WELD COUNTY, CO
OWNER NO. OWNER PERCENT INTEREST&TYPE
402010 EDDY OIL COMPANY 0.02892000%ORI
405347 TED E AMSBAUGH 0.04971000%ORI
405335 BARRY L SNYDER 0.04971000%ORI
407507 BUDDY BAKER 0.11362000%ORI
39397 DENVER MINERAL&ROYALTY CO, LLC 0.35789900%ORI
177286 TAKU RESOURCES LLC 0.40761100%ORI
56443 NOBLE ENERGY INC 0.72574000%ORI
280727 KERR-MCGEE OIL&GAS ONSHORE LP 4.69869000%ORI
402852 WELD COUNTY BOARD OF COMMISSIONERS 0.04819000%RI
405318 T JAMES D BROWNLIE 0.07473000%o RI
403343 JOHN R WALLACE 0.07473000%RI
403345 KENNETH A BREITENBACH 0.07473000%RI
405272 BWAB INC WILLIAM G MILLS II-AIF 0.19578000%RI
71866 ANNA MAE PYLE 0.23670700%RI
71870 JAMES D ANDREWS 0.23670700%RI
72040 JOHN A ANDREWS 0.23670800%RI
71873 MARY LOUISE SMYLIE TRUST 0.23670800%RI
71860 JESS PAUL ANDREWS 0.47341500%RI
71861 RUTH HELEN RENZ 0.47341500%RI
71874 ETHEL V REDIESS REV TR DTD 9/7/94 HERMAN A 0.94683000%RI
REDIESS SUCC TTEE
174125 THOMAS M SHARKEY 0.97889500%RI
72538 HOFFSCHNEIDER OIL&GAS LLC 0.97889500%RI
6473 BENSON MINERAL GROUP INC 1.53782000%RI
31071 SANDRA MARIE PURSE REID 1.95779000%RI
405945 SCOTTDALE RANCHES 1.95779000%RI
280727 KERR-MCGEE OIL&GAS ONSHORE LP 2.84826000%RI
74079 SYNERGY RESOURCES CORPORATION 80.00000000%WI
•
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.
Coun Attorney
DATE: ti I-7 1
INSTRUCTIONS TO ALL INTEREST OWNERS
DCP MIDSTREAM, LP HAS ENCLOSED A GAS DIVISION ORDER OR
TRANSFER ORDER FOR YOUR EXECUTION. IF YOU ARE RECEIVING A
DIVISION ORDER FROM DCP MIDSTREAM FOR THE FIRST TIME, PLEASE BE
ADVISED THAT WE ARE THE NEW GAS PURCHASER. IF A TRANSFER
ORDER IS ENCLOSED WE ARE EVIDENCING CHANGES OF OWNERSHIP IN
AN EXISTING WELL.
THE ATTACHED DOCUMENT SHOULD NOT BE ALTERED IN ANY WAY
EXCEPT TO CORRECT SPELLING ERRORS, UNLESS ACCOMPANIED BY
DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGE.
If your name and interest are correctly shown:
1. Sign your name as shown on the Gas Division Order
2. If your name has changed due to marriage or divorce, execute the Gas Division Order using your
present name and furnish a copy of the marriage certificate or divorce decree.
3. If signing for a corporation,signature must be attested,corporate seal affixed and of signatory
Party reflected.
4. If signed by agent, attorney-in-fact, guardian or any party other than the named interest owner,
certified copy of the power of attorney or other evidence of such party's right to sign must be
furnished.
5. Should you fail to provide your correct Social Security Number or Tax Identification Number,the
law provides that we withhold 28%of all production proceeds due you. You may also be subject
to a further penalty levied by the Internal Revenue Services.
6. Your correct mailing address should be noted in the space provided to insure prompt receipt of
production proceeds.
7. The top copy or the"Original"of the Gas Division Order should be returned to:
DCP MIDSTREAM,LP
6120 S.YALE,SUITE 1100
TULSA,OK 74136
8. Should you have any further questions regarding the enclosed Gas Division Order, please contact
your Operator or Tammy Quadnau with DCP Midstream,LP at(918)524-0644.
9. Please DO NOT DETACH the exhibit from the Gas Division Order if one is included.
Hello