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Home My WebLink About20112277.tiff a KERR—MCGEE OIL AND GAS ONSHORE DIVISION ORDER • - - -•Venture Number: 320890 ;Property Number: 1045472 Property Name: CENTEX 40-25 NB-CD . a-P ,duct: All Products WELD COUNTY BOARD OF COMMISSK}NER I • Sthl<us: NOT APPLICABLE County/State: WELD/CO 915 10TH STREET -Effective Date: DATES OF FIRST SALES Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSIONER GREELEY,CO 80632 Interest Amt/Type: 0.00018624/RI Unit Description: T2N-R68W,Sec 25:SE/4NE/4,NE/4SE/4&T2N-R67W Sec 30: SW/4NW/4,NW/4SW/4 COVERING 156.4866 ACRES,M/L OF THE NIOBRARA CODELL 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) WELD COUNTY BOARD OF COMMISSIONER *Tax ID#XXX-XX-0813 **Tax ID# P1150 0 Street , Barbara ' k er hair P.O. Box 758 At t e t: C l e r, t�/'e Bo/..rd / Signature/Corpor itiG Owner Address(if different from above) &A/MIL :a_' •. .I1 /.t Greeley, CO 80632 By: Deputy g ;•�`?i Boar Owner Signature/Corp to Title City,State Zip Code AUG 2 2 2011 Owner Daytime Phone r. %4 i . / *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 Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: July 13,2011 P.O.Box 173779 Prepared by: KPetross �l////� ``�� Denver,CO 80217-3779 1-800-677-5603 l,©0730'' ' • 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. e BY: Coun AttomLy DATE: 8-17-n KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER Venture Number: 320890 Property Number: 1045472 -- Property Name: CENTEX 40-25 NB-CD _Product: All Products A ti C- WELD COUNTY COLORADO r_, F' atus: NOT APPLICABLE CIO BOARD OF COUNTY COMMIS County/State: WELD/CO 915 10TH STREET Effective Date: DATES OF FIRST SALES Owner Number: RV37471504-WELD COUNTY COLORADO GREELEY,CO 80631 Interest Amt/Type: 0.00161675/RI Unit Description: T2N-R68W,Sec 25:SE/4NE/4,NE/4SE/4&T2N-R67W Sec 30: SW/4NW/4,NW/4SW/4 COVERING 156.4866 ACRES,M/L OF THE NIOBRARA CODELL 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) WELD COUNTY COLORADO *Tax ID#XXX-XX-0813 C/O BOARD OF COUNTY COMMIS **Tax ID# 7'l 1150 0 Street • b e , Chair F.O. Box 758 At t .t: Cl- /the Bard Otyl)r Signa e/ rate i e Owner Address(if different from above) I Ai:44 �.�s�s�:.�;• . "A Greeley, CO 80632 By: Deputy 01'0.r.1 1' •1 t-7-..%;oard . Owner Signature/ orporate Tie City,State Zip Code �F. ismAUG 2 2 2011 Owner Daytime Phone O 11/42 all 'w frio- *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 Return to: KERR-MCGEE OIL AND GAS ONSHORE Date Prepared: July 13,2011 P.O.Box 173779 Prepared by: KPelross Denver,CO 80217-3779 9D//f 77 1-800-677-5603 Cg0 730 -- I • 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* le( /2.,` `) Co my Attorney DATE: (j '7) _ft r Anadarko Petroleum Corporation Owner On-Line Access To access your checklEFT statements on-line via the internet. Go to ... WWW.oildex.com If you have not received a Check/EFT from Anadarko, Kerr McGee, Lance and Howell, no information will be posted onto the oildex website. Scroll down left side of page until you get to "Owner Relations Connect Websites" see below .:6iIdex +',6^t AP COMI'ATA ',Litt LSSLS l'PL`.,S ALLIAI4.I', DI}Yt ;OP\ CUNI At D'. le.u .vam Delivering information. Improving processes. Supporting better decisions. ',As ID Type.II owner Relations Tr(_La N, )L( if v tr1 SUCCEED — 4ldcx ._ Connect We:,;:e'. the Indunti y - l.-n,lwq p,ONd+1 Aera En,LLC Oildez is the < e-gy industry's leading provider of digital data, Anadarkarh o 4worl,fbw a wd solutions, If provides the most c: Sri vwink'9P compre henslnd ve solenutianalysison for managing revenues,ee:penzec and 4,2006mpanles Chevron J.5.A. g4.00]Users pncrrpnMps business intelligence. Devon .; P,ocnsun, Dominion Today, more than 4,200 comoamos depend on Oildox to help $80 btl,on in transaction ECG Resource treambne their business pro:esses,with services ranging detail yearly Click on Anadarko 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 are a 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 LOGIN is your Owner Number = Is your 6 digit Anadarko owner number (Example: RV12345604 or JV12345601) APC/KMG owner numbers (Not the Payee #) are located at the top of your check detail. To access oildex you only need to put in the six digit owner number123456, leave off the RV or JV and the 04 or 01 at the end if you are looking at a tax statement. TEMP Password is normaly the last 6 digits of your Tax ID/Social Security # on your account. (Example: SS# 123-45-6789 would be 456789) It will then prompt you to choose a password you can remember. New Password must be at least 7 digits long. Be sure to write your new password down and keep it in a safe place so not to forget it. If you have any other problems accessing www.oildex.com please contact Oildex support directly at: suovort(aoildex.com or contact owner.relationsaanadarko.com 1099 Misc Tax Form — go in the "Inbox" tab there is a place that states "Display 1099's" If you have several owner numbers you will need to go to each Owner number. Dear Interest Owner: 1. Enclosed are two copies of your Division Order or Transfer Order. Please execute (in front of two witnesses) the document stamped"Return This Copy"and retain the one marked"Your Copy"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 3. For CHANGE OF ADDRESS, use the enclosed form. All ADDRESS CHANGES MUST BE MADE IN WRITING. 4. NAME AND OWNERSHIP CHANGES must be submitted in wilting to the above address. Please include proper documentation confirming the change: a. For Name Changes: Marriage Certificate, Divorce Decree, etc. b. For Ownership Chances: 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. For Changes 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. 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 6. 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. 7. For access to check information: htta://www.oildex.com. For Technical Questions related to this website please call: 1-888-922-1222 (option 3). Hello