HomeMy WebLinkAbout20110532.tiff NADOA Model Form Division Order(Adopted 9/951
'm noble 4 ..l DIVISION ORDER
energy
Return To: NOBLE ENERGY, Il k i ED I I A C: 2 j Desk Code: JEM
1625 BROADWAY STE 2200 Date: JAN 05 2011
DENVER CO 80202 US Effective Date: APR 2010
Property Name: LESSER J 21-27D CN
Operator: NOBLE ENERGY, INC
County/Parish and State: WELD, CO
Property Description: Refer to next page for property description attachment
Product: ALL
OWNER NAME PROPERTY t( OWNER# INTEREST
WELD COUNTY COLORADO 435686045 124102-8 0.00034375 RI
C/O BOARD OF COUNTY COMMISSION
WELD COUNTY CENTENNIAL CENTER
P O BOX 758
GREELEY CO 80632 US
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Noble Energy,Inc.(Noble).
Noble 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.
Noble 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 Noble any amount attributable to an interest to which the undersigned is not entitled.
Noble may accrue proceeds until the total amount equals$25,or pay proceeds with a balance of $10 or more annually in September of each year,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 Noble may have certain statutory rights under the laws of the state in which the
property is located.
Special Clauses:
Owner(s)Signature(s): Barbara Kirkmeyer, Chair
FEB 2. ? 2011
Owner(s)Tax I.D.Number(s):
TIN(s)or SSN(s) 84-6000-813
Owner Daytime Telephone/Fax#: 970-356-4000 X4200
Address Correction:
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 Noble Energy,Inc.
2011-0532
LE D\b\
NOBLE ENERGY,INC. Property Description Attachment
Property Name : LESSER J 21-27D CN
Operator : NOBLE ENERGY,INC
County/Parish and State : WELD, CO
Property Description
72
T5N R66W SEC 21:N2N 16:S2SE
LEO/j/
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. .X' /
c1—Count Attorney
✓ "DATE: vZ —/177—/i
Dear Interest Owner:
Please read carefully before signing the enclosed oil and gas division orders:
1. Your interest as shown on this instrument should not be altered in any way unless
accompanied by documentary evidence to support the change. We may reject any
division orders changed without our approval. On ti()
j;1c,'.
2. Furnish in writing any change of address information and include your signature.
For change in ownership, furnish copies of properly filed and recorded legal
documents affecting title of interest ownership under which payment is made.
Provide a letter describing effect of change.
3.
4. If signing for a corporation, signature must be attested, corporate seal affixed and
title of signatory party shown.
5. If the instrument is signed by an agent, attorney-in-fact, guardian, estate
representative, trustee or any party other than the named interest owner, we must
have evidence of the rights vested in the signatory party.
6. If an interest is shown jointly for more than one person, each party must sign the
division order in the manner that his or her name is shown thereon. In the event
one party has been designated agent for the joint interest shown or he/she has been
granted a power of attorney for the other party(ies), we must have evidence to this
effect.
7. Insert your Tax Identification Number or Social Security Number, whichever is
applicable, in the space provided.
8. Confirm the address to which checks are to be mailed. If different, please provide
the correct address. You should notify us promptly of any changes in your
mailing address.
9. Return the executed instrument without delay to the address below.
• L
RETURN SIGNED DIVISION ORDER TO:
NOBLE ENERGY, INC.
ATTENTION: MARILYN PEOPLES
1625 BROADWAY, SUITE 2200
DENVER, CO 80202
WITH QUESTIONS OR CONCERNS
REGARDING YOUR DIVISION ORDER
PLEASE CONTACT JOEL MCKINLEY
DIRECT: (303) 228-4477 FAX: (303) 228-4287
Hello