HomeMy WebLinkAbout20100391.tiff DIVISION ORDER
To: Petro-Canada Resources(USA) Inc. Date: February 3, 2010
999 18th Street, Suite 600 YOUR COPY Effective Date: First Production
Denver, CO 80202-2499
Property Number 17606 Bpi D 5_fl3-aW3s
Well Name: Fabrizius 28-42
Operator: Petro-Canada Resources (USA) Inc.
County and State: Weld County, Colorado
Property Description: T11N R61W, Section 28: NWl4SE/4
Production: Oil X Gas X Other X
Owner Name and Address: Owner Number: 102098
Weld County Board of County Commissioners
Weld County Centennial Center Type of Interest: RI
915 10th Street
Greeley, CO 80632 Decimal Interest: .12500000
The undersigned certifies the ownership of their decimal interest in production or proceeds as described on
Exhibit"A" payable by Petro-Canada Resources (USA) Inc. (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 regarding the interest in production
claimed herein by the undersigned.
The undersigned agrees to indemnify and hold Payor harmless from and against any and all liability, loss,
costs, damage and expenses (including, but not limited to, attorneys' fees, court costs and interest at the
statutory prejudgment rate on funds improperly paid to the undersigned), relating to or in any way arising from
from payments made under this Division Order, including payments mistakenly made to the undersigned, or
otherwise attributable to the interest in production claimed by the undersigned. In the event of any mistake in
such payments made to the undersigned, the undersigned shall immediately refund such payments to Payor.
Payor may accrue proceeds until the total amount equals$25.00, or pay once a 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 Payor may have certain
statutory rights under the laws of the state in which the property is located.
Special Clauses: None
Owner(s) Signature: Stf/q rlpa—C
Doug1 Rade acher, Chair FEB 2 2 2010
Owner(s)Tax ID Number(s) 84-6000-813
Daytime Telephone No. (970)336-7204 X4200 Attest:
Cl k to the a
FAX Telephone No. (970)352-0242 By : e
Deputy Cle to the
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 Payor. a&62/2- 39/
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PETRGCANADA* Petro-Canada Resources (USA) Inc.
February 3, 2010
Dear Interest Owner:
Re: Property No. 17606 Fabrizius 28-42 T11 N, R61 W, Section 28: NW/4SE/4
Weld County, Colorado
Enclosed are two copies of Petro-Canada's Division Order covering the referenced well(s)which
Petro-Canada has drilled and recently placed on line. Please sign one copy of the Division Order
according to the enclosed instructions and return the signed Division Order to our office. The second
copy is for your files. A return envelope is enclosed for your convenience.
We appreciate your cooperation in signing and returning the enclosed Divison Order at your
earliest convenience. If you have any questions or concerns, please call me at 303-350-1201.
Very truly yours,
)j77/(a.L t
Marlene Boyle
Senior Division Order Analyst
MB:mh
Enclosures
2010-0391
L 111' 11 . C�('1Y(�k Suite 600,999 18th Street • Denver, CO 80202
Office:(303)297-2100 • Fax(303)297-7708 • www.petro-canada.ca
C 3H(7t;C
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: 1,, 'L ,' ; L `< -
County Attorney
I 1
,
DATE: -- _/ / i `
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