HomeMy WebLinkAbout20110027.tiff NADOA Model Form Division Order(Adopted 9/95)
DIVISION ORDER
To: Weld County I Board of Date: December 7, 2010
Commissioners
Property Number: Effective Date: 1n date of production} "-- i 3 5• c!: l 0
Property Name: See Exhibit"A" Lease No.:
Operator: Bonanza Creek Energy Operating Company, LLC
County and State: 4• > -_y
Property Description:
Production: Oil Gas Other:
Owner Name Weld County Board of Commissioners OWNER NUMBER: 1041
And Address: P 0 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. i
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 B and of Commissioners
Owner(s)Signature(s):
.fitb// t.- Barbara Kirkmeyer, Chair
Owners)Tax I.D.Number(s)
84-6000-813 AN 042011
Owner Daytime Telephone#: 970-356-4000 X4200 Attest:
Clerk to the ar
Owner Fax Telephone#: 970-352-0242 B : •
Deputy Cle to t B r
tr* +i
Federal Law requires you to furnish your Social Security of Taxpayer Identification Numb 061
'4^
Failure to com I will result in 31% tax withholdin and will not be refundable b Pa or.
2011-0027
LEt)` 1S
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
PRONGHORN 12-9 RI �foa L3 0.125 Suoct mtis-I 59 Ts ro R ;stk.)
B1k PRONGHORN 14-4 RI LE i a 0.0625 swyswy of ?-so R(.0\,-)
\L)
PRONGHORN43-15 RI LSOD%l 0.125 Me-Li t; T-•,, ri,+t`�
Rik WELDCOUNTY22-15 RI LEC>;i(4 0.125 SEA nwaq s)s SN iw
OK PRONGHORN 34-22 RI r.r, cw 0.125 Stu4 sE'?. Sa; 15N kIjI W
OILPRONGHORN 31-21 RI L-E-0al 0.125 NUS-1 rtay ) ' 5"'":pia
c NORTH PLATTE 31-34 RI /E O!7 p 0.2 4'k Mato. 53,/ '5P-t PLJ3
jt .NORTH PLATTE 41-34 RI LEp17,3 0.2 na_ANE4 S34 T3NRis3'il
•
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: IGteG:f
Coun Attorney
DATE: /2 22 ��
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