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Home My WebLink About20101285.tiff -ERR-MCGEE OIL A s. GAS ONSHORE DIVISION ORDER ©O o Venture Number: 317707 Property Number: 3039048 Property Name: KUNZMAN FEDERAL 9-66 NB-CD Product: All Products WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE County/State: WELD/CO 915 10TH STREET Effective Date: DATE OF FIRST SALES Owner Number: RV 37471404-WELD COUNTY BOARD OF COMMISSIONE GREELEY,CO 80632 Interest Amt/Type: 0.00142812/RI Unit Description: T2N-R66W,Sec 6: SE/4 COVERING 160 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) A r y�I O5-a3 - 2O464-121 WELD COUNTY BOARD OF COMMISSIONER *Tax ID#84-6000813 **Tax ID# j ATTE.T: 1� �,�i�w" �� Owne ignature/Corporate Title Owner Address(if different from above) �( i>�., 1 *•' � .:; 1 Douglas Rademacher, Chair By: Depu gYi T:t �� ,_ JUN ,� 4.2010 City,State Zip Code Boar.i r , • N ,{ -% 970-356-4000 X4200 "c'`�1 Owner Daytime Phone 4 *Failure to famish 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 y,- Date Prepared:May 28,2010 �� evQ/oz P.O.Box 173779 eel/44/-44-r y�c. `/ �' Prepared by. Katie Petross Ole-- /G7p5 Denver,CO 80217-3779 l �!, '7Q �J O 1.800.677-5603 !D 7 oC Dear Interest Owner: Enclosed are two copies of the Division Order or Transfer Order. Please execute (sign in front of witnesses) the original and retain the one marked"Copy"for your records. 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. 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 does not match the name on your Social Security Card, please advise us, in writin4, of the differences. Please address all correspondence, including your executed Division Order, to the following address: Ken—McGee Oil &Gas ore Attn: Division Orders P.O. Box 173779 enver, CO 80217-3779 Address changes must be s gned byme owner and submitted to the above address. Provide your Owner Number, Social Security Number, both the old address AND new address and new telephone number. Please note that Royalty Checks ARE NOT forwarded by the Post Office. Name and Ownershio Changes must be submitted in writing to the above address. Please include proper documentation confirming the change: ❑ For Name Chanciest Marriage Certificate, Divorce Decree, etc. u For Ownership Chanciest Deeds, Assignments, etc., must be recorded in the County (Parish) in which the property is located prior to sending them to our office. The copy of the document sent in must have evidence of the recording (e.g., the recording stamp) on it. ❑ 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. When you wish to make an inquiry or request a change, please have available as much of the following information as you can: (1) Owner Number (2) County and State where well is located (3) Well name and/or property number (4) Your telephone number with AREA CODE Direct Deoosltt In order to improve our payment process Anadarko Petroleum Corporation and its subsidiaries have implemented an optional Direct Deposit program that will enable you to receive electronic funds transfers (EFT) in lieu of mailing revenue checks. If you choose to enroll in this program, you will still receive your check detail in the mail. Please call our Customer Relations Hotline at the number listed below for more information on EFT's. Anadarko Customer Relations toll-free telephone number: 1-800-359-1692. Or, you can access our CUSTOMER WEBSITE: httos://connect.oildex.com/aoc. For Technical Questions related to this website please call: 1-888-922-1222 ext. 191 Our Customer Relations Agents are available between 9:00 to 11:00 am and 2:00 to 4:00 pm, CST, Monday Through Friday. Outside those hours, or in times of exceptional call volumes, you will be directed to leave a voice message. Our goal is to return your call within 48 hours. • 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. / I Coun y Attomey DATE: GJ 7/ Hello