HomeMy WebLinkAbout20091758.tiffColton LLC
NADOA Model Form Division Order (Adopted 9/951
OWNER:
Weld County Colorado
ATT: Clerk to the Board
915 10'" Street
Greeley, CO 80631
Effective Date: First Production
Prospect Name:
Property Name and Number
Operator:
County and State:
Property Description:
Production: Oil:
Evans
Dos Rios 12-34A
Colton LLC/
Weld County, CO
Township 5 North, Range 66 West
Section 34: N/2SW/4
Type of Interest: Royalty Interest
Decimal Interest: 0.00541786 /
Gas: X
Codell and Niobrara Formations Only
Other:
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Colton
LLC (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 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 in which the undersigned is not entitled.
Payor may accrue proceeds until the total amount equals $25, or pay annually, if amounts are greater than $5, 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 and/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: if applicable, see attached Exhibit.
Owner(s) sins re(s):
William F. Garcia, Chair
Owner(s) Tax I.D. Number(s):
Owner(s) Daytime Telephone #:
Owner(s) Fax Telephone #:
Witness or Attest:
ATTEST:
.11Th 2.s2009 BY:
84-6000-813
970-356-4000 X4200
970-352-0242
Deputy Cler
Federal Law Requires you to furnish your Social Security or Taxpayer Identification Number. Failure to comply will result in 31% tax
withholding and will not be refundable by Pavor.
2009-1758
07bci tot
621 17' STREET, SUITE 950, DENVER, COLORADO 80293 m (303) 297-0347 @ FAX (303) 297-9075
PC `. l occ-r>tii 6 6ti1c,
07 /5047
Lt. 0 713
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.
DATE / / D �7
Colton LLC
Dear Owner/Payee:
Please review, sign and return the enclosed division order. The purpose of the division order is to provide
you information about your ownership and to obtain certification from you that you are the correct person
to whom payments for this interest should be made, or that you have transferred your property interest to
others. Our division order conforms to the Model Form Division Order endorsed by the National
Association of Division Order Analysts and the National Association of Royalty Owners.
The following suggestions are made to assist you in completing and returning this division order:
+ Review the decimal interest in the property described. If you have transferred your property
interest your name will appear as the Transferor and the party who received your interest will be
listed as Transferee.
+ Supply and/or verify your Social Security or Tax Identification Number. Without your correct tax
identification number, we have to withhold 28% of your payments for the Internal Revenue
Service.
+ Make sure your payment address is correct.
If your name has changed or ownership has changed, please notify us in writing via mail or fax
and provide proper documentation (e.g., marriage certificate, divorce decree, deed, will, etc.)
Proper documentation is necessary to avoid suspension of your funds.
+ If you are signing for some other person, please attach documentation (e.g., Power of Attorney).
Payments are made upon accrual of $25 for all of the properties paid you by our company or annually, if
amounts are greater than $5. Amounts less than $5 are paid either upon accrual after the first year or
when we cease paying you for your interests. Should you require payment on a more frequent basis,
please contact us and we will remit to you as frequently as provided by State statutes.
After you have reviewed the division order, please sign one copy and return to us. The other copy of the
division order should be retained for your records.
Sincerely,
Maria Ray
Accountant
621 17TH STREET, SUITE 950, DENVER, COLORADO 80293 N (303) 297-0347 da FAX (303) 297-9075
COLTON LL C
621 17T" STREET, Sure? 950 * DENVER, Cot,olAno 80293 * VoicE 303-297-0347 * FAX 303-297-9075
July 8, 2009
Interest Owner:
Our records indicate that we have not received an executed Division Order for the interest indicated in the
enclosed Division Order. We have enclosed another Division Order and ask that you please sign and
return the Division Order in the enclosed self-addressed envelope. If you have previously executed such,
we apologize for the inconvenience but would appreciate if you would execute the enclosed Division
Order and return it to us.
Any suspended revenue will be released for payment as soon as we receive the executed Division Order.
Your help with this matter is greatly appreciated.
ours truly,
OtA--t,a-
Maria C. Ray
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