HomeMy WebLinkAbout20113152.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 318658
Property Number: 1093017
Property Name: BADDING 38-26 JSND
Product: MI Products
WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE
County/State: WELD/CO
PO Box: 758 Effective Date: DATES OF FIRST SALES
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER
GREELEY,CO 80632 Interest Amt/Type: 0.03 125000/RI
Unit Description:
T2N-R66W,Sec 26:SE/4SE/4,Sec 25: SW/4SW/4,Sec 35:
NE/4NE/4&Sec 36:N W/4NW/4 COVERING 160 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)
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WELD COUNTY BOARD OF COMMISSIONER *Tax ID#XXX-XX-0813
**Tax ID#
Attest: ` /
4/(4,444 i.1 Mu‘,74 _______
Clerk to t Bo /Owner Signature/C�q orate p Title` Owner Address(if different from above)
B „7 _ % 2 Barbara Kirkmeyer, Chair
Deputy Cle 1-E '77 e Board City,State Zip Code
Altr �ie
,pd DEC 1 2 2011
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�`� Owner Daytime Phone
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,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
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Return to: KERR-MCGEE OIL AND GAS ONSHORE a
L� ', vY'mr,-f�-let Date Prepared: November 28,2011 /�
P.O.Box 173779 y Prepared by: KATIE PETROSS L-�— D�2
Denver,CO 80217-3779 �' ' I J I '
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.
BY: LEd � Lc"
County Attorney
DATE /z 2 //
KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 318658
Property Number: 1093017
Property Name: BADDING 38-26 JSND
Product: All Products
WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE
County/State: WELD/CO
PO Box:758 Effective Date: DATES OF FIRST SALES
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSION
GREELEY,CO 80632 Interest Amt/Type: 0.03125000/RI
Unit Description:
T2N-R66W,Sec 26:SE/4SE/4,Sec 25:SW/4SW/4,Sec 35:
NE/4NE/4&Sec 36:NW/4NW/4 COVERING 160 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)
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WELD COUNTY BOARD OF COMMISSIONER *Tax ID#XXX-XX-0813
/ **Tax ID#
,/7/1 j
Attest: G16L411
Li c '
Clerk to t Bo I Owner Signature/C orate Till Owner Address(if different from above)
By_j , / /L,./ Barbara Kirkmeyer, Chair
Deputy Cle - - Board City,State Zip Code
(4%'lio DEC 1 22011
Owner Daytime Phone
(19: x z " _
186`, - - k�
; 7
65)17/11/A4/
/a-ia- 2)7'4--
*Failure to famish 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
0740/I-3 O1
Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: November 28,2011
P.O.Box 173779 Prepared by: KATIE PETROSSDM
Denver,CO 80217-3779
-
1-800-677-5603
Direct Deposit: Enrollment Form - Required for Payment AnadarkEl
Petroleum Corporation
Contact Information
Last,First and Middle Initial(or Company Name) Owner Number/SSN
Address,City,St,Zip
Email Address(required for check statement notification) Phone Number
Authorization
With my signature below,I confirm that I am a revenue interest owner or an authorized representative..I agree that the terms and conditions of all agreements with
Anadarko Petroleum Corporation and/or its subsidiaries(`Payor')concerning method of timing of payments shall be amended as provided herein.Payor assumes
no responsibility for any loss initiated by errors,omission or delays caused by my depository bank..Payor assumes no responsibility for fees or deductions made by
my depository bank.I agree to hold Payor harmless and indemnify Payor from and against all liabilities,claims,losses,costs,expenses and damages of any kind
including direct,indirect,consequential and punitive asserted against Payor directly or indirectly from or arising out of the electronic transfer of funds contemplated
by this enrollment form.I hereby authorize and request Anadarko Petroleum Corporation to make payments via electronic transfer into the referenced account and
statement notification to be electronically emailed to the email address above upon account activation.I have read and agree to the terms and conditions in the
attached direct deposit information sheet.
Signature is required.
Printed name(s) Signature(s) Date
Bank Information
Complete the banking information below or include a pre-printed voided check or savings deposit slip(PDF or scanned copy is
acceptable).Savings deposit slips do not always contain the correct routing number.Please confirm ABA number with your bank
before submitting.
Bank Institution Name
ABA or ACH Routing Number Account Number
Account Type:Checking,Savings,Money Market
Return To
Anadarko Petroleum Corporation Note:Anadarko Petroleum Corporation maintains several subsidiaries.
Timberloch—BA Group The return address provided on this form is acceptable for all
P.O. Box 1330 subsidiaries.
Houston,TX 77251-9874
Fax:(832)636-5048
Email: Business_Associates_Requests@anadarko.com
A scanned version (PDF)of your signed form with bank information is acceptable.
Paper Option
O I would like to receive a paper check. By checking this box, I acknowledge that paper checks are less secure because of the
mailing and distribution processes.
L
Direct Deposit/ACH Interest Payment Information Sheet Anadarlip2
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When will the funds be deposited?
Funds transfers will be initiated via Automated Clearing House(ACH)electronic transfer on the day before checks are mailed. The
transfer is expected to take place in less than 24 hours.This will provide more immediate access to your funds and result in a more
convenient and secure transaction.
What will happen to the property-level detail that normally comes with my check?
If you elect to enroll in the ACH program,you will be automatically enrolled in the"Stop Paper Detail"service provided to you at no
cost through the secure Anadarko Owner Relations Website.To activate your account, login to the Anadarko Owner Relations
Website at https://connect.oildex.com/apc/ using your Anadarko Owner Number and your initial temporary password which is the
last six digits of your Social Security Number or tax ID. Your revenue payment and property-level details are immediately available
for online viewing at the time of the deposit into your account. Once your account is activated,you will receive an email notification
when a new statement is available.
How do I elect to receive the property-level details via e-mail?
If you do not want to login to your account every month,you can elect to have your statements emailed directly to you.To select
this option,first, login to the Anadarko Owner Relations Website at https://connect.oildex.com/apc/using your Anadarko Owner
Number and password.Your initial temporary password is the last six digits of your Social Security Number or tax ID.Then,click on
the"My Profile"tab;click on "Change Email Address ... ":check both "Send email notification ... "AND"Send data .... ":and be sure
to provide a password for the data file. For assistance, please contact Oildex technical support at support@oildex.com.
Can I direct funds to more than one account?
Deposits can only be sent to one account.
What type of accounts can be used for Direct Deposit?
Any account that accepts ACH transfers can be used in the program (this includes money market accounts). If you are unsure as to
whether your bank or investment firm is set up to accept ACH transfers, please contact your institution prior to returning your
enrollment form. If we encounter difficulty during the setup and testing process, you will be notified using the contact information
you have provided.This may delay the start date for you to receive electronic deposits.
What happens if I need to change the deposit account at a later date?
Changes to your banking information and contact information can be made at any time in writing. Please remember to notify us
thirty(30) days before closing or changing an account that you are using for electronic deposits. If changes are not communicated
before an ACH transfer is declined by your bank, it will cause a delay in the receipt of your funds.
How soon will the electronic deposits start after you receive my enrollment form?
Depending on the date your form is received and processed, Direct Deposit will begin either at the end of the current month or the
following month. (If Direct Deposit does not begin until the following month,a check will be issued for the current month.)
Will there be any changes to year-end reporting?
There will be no change in year-end reporting.You will receive information on IRS Form 1099 which will be mailed to you and also
available via the Anadarko Owner Relations Website at https://connect.oildex.com/apc/
Who is my contact for questions regarding Direct Deposit?
For further information, please contact the Customer Relations department via phone 1-800-359-1692 or email
Owner.Relations@Anadarko.com
Anadarko Petroleum Corporation
Owner On-Line Access
To access your Anadarko Petroleum Corporation and/or it's subsidiaries such as Kerr McGee, Howell, etc
royalty check/EFT statements. In addition to viewing and printing your check detail, you will be able to
create simple revenue reports, get answers to frequently asked questions, pull copy of your 1099 Misc Tax
form and prepare change of address forms on-line via the internet. Go to ... www.oildex.com
Scroll down left side of page until you get to"Owner Relations Connect Websites"see below Click on
"Anadarko".
�ildex 0 ePayabies 0 eiuogeting O eRevenue D*Statements O Client Login
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Then click on View Documents and Reports - (click here to login) Log in here and it will prompt you to
put in your Login and password. NOTE: If you area first time user be sure to click on First-time
users: click here! . It will then prompt you to put in your Login and Temp Password (see below
instructions)
First time users (Please note a check/EFT must be issued first before an Oildex account is
set up. If you have not received a royalty check no information will be posted in oildex.)
Please be sure to click on " I am a first time user " then
User ID = (Your 6 digit Owner Number. Do not include the RV or O4 at the end, that is for internal use
only.)
Temp Password = (typically the last six digits of Social Security Number (SSN) or Tax ID Number
(TIN) associated with the account * (or a unique temporary password, see below)
Then it should prompt owner to put in a permanent password, must be at least 6 alphanumeric
characters. A confirmation email which will include the password you have chosen will be emailed to you.
* (We subscribe to Oildex and they are requested to use the last 6 digits of SSN/TIN as the Temp password,
however, we have found that in some cases if Oildex does not have the SSN/TIN at the time of set up they will
choose a unique temp password other than the last six digits of SSN/TIN. In this case the owner may call or e-
mail CRM-Revenue@anadarko.com 1-800-359-1692, Option 2. Please note we will require the
ml Owner Number along with the ON / Tax ID # associated with the account in order
to provide you with the Temporary Password.)
If you have any other problems accessing www.oildex.com please contact Anadarko Petroleum Corp. at
CRM-Revenue@anadarko.com or Oildex support directly at: support@oildex,com
0\ ' Check out the new Anadarko Owner Relations Website: Go to www.anadarko.com click on
About Anadarko, then click on Owner Relations. Our new owner relations website provides
details in regards to owner issues. This is a helpful tool to utilize for issues about royalty checks,
VJ� owner interest questions and much more!
Dear Interest Owner:
1. Enclosed are two copies of your Division Order or Transfer Order. Please execute the first copy in front of two
witnesses and provide a valid Social Security Number or Tax Identification number. The second copy marked
"Copy"is for your records.
a. Sign exactly as shown on the Division Order or Transfer Order. Signatures must be witnessed by two
people. If joint ownership, all owners will be required to sign, but may sign separate copies.
Signatures by Agents, Attorneys-in-Fact, Guardians or Trustees must be verified by attaching evidence
of the right to sign in that manner, such as a copy of the Power of Attorney.
b. Include the correct Social Security Number or Tax Identification Number in the space provided.
Failure to furnish this information may result in withholding tax in accordance with
federal law and any tax withheld will not be refundable by payor. If the name on the Division
Order or Transfer Order does not match the name on your Social Security Card, please advise us, in
writing, of the differences.
2. Please address all correspondence, including your executed Division Order, to the following address:
Kerr McGee
Attn: Division Orders
P.O. Box 173779
Denver, CO 80217-3779
3. For CHANGE OF ADDRESS, please submit all changes to the above address. All ADDRESS CHANGES
MUST BE MADE IN WRITING.
4. NAME AND OWNERSHIP CHANGES must be submitted in writing to the above address.
In order to process the name and ownership changes, we require the following documentation:
a. Name Chanaes: Marriage Certificate, Divorce Decree, etc.
b. Ownership Chanoes: Deeds, Assignments, etc., must be recorded in the County (Parish) in which
the property is located prior to sending them to our office. Copy of the document sent in must have
evidence of the recording (e.g., the recording stamp) on it.
c. Chanoes due to Death of an Owner: As a general rule, we require complete copies of probate
proceedings rendered by a court having jurisdiction over the property in question. If the Estate was
not probated, or if it was probated in a different state, other documentation may be required.
5. Anadarko Customer Relations toll-free telephone number: 1-800-359-1692. Our Customer Relations
Agents are committed to monitoring and returning calls in a timely manner. Our goal is to return your call
within two business days.
6. When you wish to make an inquiry or request a change, please have available as much of the following
information as you can:
-Owner Number
-County and State where well is located
-Well name and/or property number
-Your telephone number with AREA CODE
7. For access to check history information: http://www.oildex.com, or refer to the attached instruction sheet.
For Technical Questions related to this website please call: 1-888-922-1222 (option 3).
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'1sG�
w
;
County Attorney
DATE: /Z— 2-/
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