HomeMy WebLinkAbout20112335.tiff NADOA Model Form Division Order(Adopted 9/951
re noble DIVISION ORDER
energy
Retum To: NOBLE ENERGY,INC Desk Code: AEB
1625 BROADWAY STE 2200 - : Date: AUG 03 2011
DENVER CO 80202 US '- • - I'' Effective Date: OCT 2010
Property Name: BASHOR 17-11 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# OWNER# INTEREST
WELD COUNTY COLORADO 435778192 124102-14 0.00250000 RI
BOARD OF COMMISSIONERS
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: RETAIN FOR YOUR RECORDS -, 7 7
Owner(s)Signature(s): Barbara Kirk eyer, Chair (lip S �G (/
Owner(s)Tax I.D.Number(s): 84-6000-813 LUG 2 0 2011
TIN(s)or SSN(s)
Owner Daytime Telephone/Fax#:
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.
(146/11.,
2011-2335
NOBLE ENERGY.INC. Property Description Attachment
Property Name : BASHOR 17-11 CN
Operator : NOBLE ENERGY,INC
County/Parish and State : WELD, CO
Property Description
T6N R63W SEC 17:N2NE
NOBLE ENERGY INC.
1625 Broadway, Suite 2200
Denver, Colorado 80202
August 3,2011
Interest Owner
Re: Property Name : BASHOR 17-11 CN
Operator : Noble Energy, Inc.
County/State : Weld Co., CO
Noble Energy Inc. has successfully recompleted the above referenced property in the Niobrara formation. First sales
occurred November 18, 2010. According to our records, the interest shown on the attached division order represents
your total share of production. Noble will tender payment to you based upon the stated interest UNLESS you notify
Noble, in writing, that said interest is incorrect or that you are not the owner of said interest. Since ownership is the
same, Niobrara production is booked with the Codell production. You will see only one entry on your check for both
formations, beginning with the date of first sales.
As the owner of the above interest, you shall have the sole liability to notify Noble, in writing, of any address changes
and/or changes in ownership. Until such written notification is received by Noble, payments will continue as
previously described.
Please be advised, however, that payments are made upon accrual of twenty five dollars ($25.00) for all of the
properties paid to you by our company or annually, on amounts less than twenty five dollars ($25.00).
Please be advised that Noble does not require a signed Division Order as a prerequisite for payment. This Payment
Letter is intended to replace the traditional division order form and should be retained for your records.
If there are any questions concerning this matter, please contact the undersigned.
Ashley E. Buckner
Land Department
303-228-4487 Atajatetit.
Desk Code: MVP
•
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.
B • ,s€C---'it�� .
�Coun Attorney
DATE: S1-2,3 -11
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