HomeMy WebLinkAbout20110023.tiff NADOA Model Form Division Order(Adopted 9/05)
DIVISION ORDER
To: Weld County - Board of Date: December 7, 2010
Commissioners
Property Number: Effective Date: 1n date of production• ' 3 �i +" L v
Property Name: See Exhibit"A" Lease No.:
Operator: Bonanza Creek Energy Operating Company, LLC
County and State: 'I ,
Property Description: PP( O 5-I?3-a a O�
Production: Oil Gas Other: U
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. v
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:
W d County Board of Commissioners
Owner(s)Signature(s): j
Barbara Kirkmeyer, Chair
// JAN 032011
Owner(s)Tax I.D.Number(s) 84-6000-813
Owner Daytime Telephone#: 970-356-4000 X4200 Attest:
Clerk to t e Boar
Owner Fax Telephone#: 970-352-0242 By �r ���' •l1�``
Deputy Cler o i7 e
Y
T
12
Federal Law requires you to furnish your Social Security of Taxpayer Identification Num�',•�kot CJ ��
Failure to comply will result in 31% tax withholding and will not be refundable by Pa yo' r,
2011-0023
LE oaia
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
(jt PRONGHORN 12-9 RI LEoal3 0.125 SWUNr'' i St) T , n I.. 'fit..,::
a,PRONGHORN 14-4 RI 1 CA?, ,; 0.0625 SioA L L' `:'7 1- ,n) x- ,;..
tlt-PRONGHORN 43-15 RI e0081 0.125 II , , , >'" r 1O
Dk WELD COUNTY 22-15 RI LEt1i'1 0.125 s'growu Srs is N k , w
Ok PRONGHORN 34-22 RI ; r ualt, 0.125 Swy sf a 3- a in kt0
DVPRONGHORN 31-21 RI 'E0al 0.125 N.0+ mt ; 1 ;er.;, .,, .3
NORTH PLATTE 31-34 RI 66 O173 0.2 W,"-‘ N`--" �3 a '51' P ='
Lt NORTH PLATTE 41-34 RI ..E0I7 ) 0.2 r`°--7eJ'✓; `3(t T5t) t r: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..,7.c:.;
BY: is sd:r/ rim
Mir County Attorney
�' DATE: /2-2 2- -16
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