HomeMy WebLinkAbout20113148.tiff NADOA Model Form Division Order(Adopted 9/951
t� noble DIVISION ORDER
energy
Return To: NOBLE ENERGY,INC Desk Code: PVM oVw_ 113755
1625 BROADWAY STE 2200 Date: NOV 15 2011
DENVER CO 80202 US Effective Date: FEB 2011
Property Name: BASHOR PC AA 17-02 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 435792853 124102-14 0.00250000 RI
BOARD OF COMMISSIONERS
1150O ST
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: rirAIN FOR Y9UR/R,,E,CORDS
Owner(s)Signature(s): U!.(rA / tAie t Attest: DEC 1 22U11
arbara Kirkme}ier, h r Cle to the rd LL
Owner(s)Tax I.D.Number(s): v '
i
TIN(s)or SSN(s) 84-6000-813 By;q� ;t'I,Ty,'� -ed�M_�
Deputy Cle lilJJ� Board
Owner Daytime Telephone/Fax#: `yOtr�� '
Address Correction: 166 niti eta
Federal Law requires you to fumish your Social Security or Taxpayer Identification Number.Failure to ZaR1 .y+ill tax withholding in accordance with
federal law,which-willnot be refundable by Payor. - - -
8 __ �^ 2011-3148
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NOBLE ENERGY.INC. Property Description Attachment
Property Name : BASHOR PC PA 17-02 CN
Operator : NOBLE ENERGY,INC
County/Parish and State : WELD, CO
Property Description
T6N R63W SEC 17:N2NE,CONTAINING 80.00 ACS M/L,WELD CO.,COLORADO
NOBLE ENERGY INC.
1625 Broadway,Suite 2200
Denver, Colorado 80202
November 15,2011
Interest Owner
Re: Property Name : Bashor PC AA 17-02D CN
Operator : Noble Energy, Inc.
County/State : Weld, CO
Noble Energy Inc. has successfully completed the above referenced property. First sales occurred March 17,2011.
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.
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 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.
Patricia Minerich
Land Department
303-228-4438
Desk Code: Julie
•
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:
Coun Attorney
DATE: 42' 7
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