HomeMy WebLinkAbout20101948.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 321820
Property Number: 1062795
Property Name: CAMENISCH DAVID GU 1 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: RV37471404-WELD COUNTY BOARD OF COMMISSIO.
GREELEY,CO 80632 Interest Amt/Type: 0.00144125/RI
Unit Description:
T2N-R68W,Sec 10:NE/4,CONTAINING 160 ACRES MORE OR
LESS IN 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#84-6000813
**Tax ID#
Attest:",
Sigiature of Witness Owner Sig. a e . i 1 ate Title Owner Address(if different from above)
Lyle k to t �+
B : Dou_lE, ?la.emacher Chair
Signature of W ss cF+`; Owner Signature/Corporate Title City,State Zip Code
Deputy r Bf0A;C} Bo ...
ss 970-356-4000 X4200
Owner Daytime Phone
3\\'�"t 4 y /j AUG 2 3 2010
703 I b A S: 118
\t
*Failure to famish your Social Security/Tax ID number will result in withholding tax in accordance with federal law end(aplinoki.riihliolaviLCnir be refundable by payor.
Ll YL5C,i1' "Insert Tax ID number for all individual parties listed above in the Name and Address box
Return to: KERR-MCGEE OIL AND GAS ONSHORE (Sc., . Q,Y'I' C-C tt JPs'\5) Date Prepared:July 2010-1948
fa,1O P.O.Box 173779 -(O Prepared by: Kati
Denver,CO 80217-3779
1-800-677-5603 LE o a q 8'
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 writing, of the differences.
Please address all correspondence, including your executed Division Order, to the following
address:
Kerr-McGee Oil &Gas Onshore
Attn: Division Orders
P.O. Box 173779
Denver, CO 80217-3779
Address chances must be signed by the 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 Ownership Chances must be submitted in writing to the above address. Please include proper
documentation confirming the change:
❑ For Name Chances: Marriage Certificate, Divorce Decree, etc.
❑ 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. The copy of the document sent in
must have evidence of the recording (e.g., the recording stamp) on it.
❑ For Chances 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 Deposit: 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: https://connect.oildex.com/apc.
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.
BY:
iuO
4Counttomey
DATE: e- l 1 -i G
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