HomeMy WebLinkAbout20092877.tiffNADOA Model Form Division Order (Adopted g(95
noble
energy
Retum To:
Property Name :
Operator :
County / Parish and State :
Property Description :
Product :
NOBLE ENERGY, INC
1625 BROADWAY STE 2200
DENVER CO 80202 US
FRENZEL B 15-25 CN
NOBLE ENERGY, INC
WELD, CO
Refer to next page for property description attachment
ALL
DIVISION ORDEF
Desk Code: DESK1 ofai-
Date : OCT 14 2009
Effective Date: MAR 2008
OWNER NAME
PROPERTY #
OWNER #
INTEREST
WELD COUNTY COLORADO
C/O BOARD OF COUNTY COMMISSION
WELD COUNTY CENTENNIAL CENTER
P O BOX 758
GREELEY CO 80632 US
435661486
124102 - 8
GWI NRI
0.00000000 0.00121830
Type RI
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:
Owner(s) Signature(s):
Owner(s) Tax I.D. Number(s):
TIN(s) or SSN(s)
William F. Garcia
84-6000-813
Owner Daytime Telephone/Fax #: 970356-4000 X4200
Address Correction :
OCT 2 2009
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 Noble Energy. Inc.
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2009-2877
NOBLE ENERGY, INC Property Description Attachment
Property Name
Operator
County/Parish and State
Property Description
T5NR64W Sec15:SW/4
: FRENZEL B 15-25 CN
: NOBLE ENERGY, INC
: WELD, CO
Dear Interest Owner:
Please read carefully before signing the enclosed oil and gas division orders:
Your interest as shown on this instrument should not be altered in any way unless accompanied by
documentary evidence to support the change. We may reject any division orders changed without our
approval. Do not detach Exhibit "A", if applicable.
2. Furnish in writing any change of address information and include your signature. For change in ownership,
furnish copies of properly filed and recorded legal documents affecting title of interest ownership under
which payment is made. Provide a letter describing effect of change.
3. Sign your name EXACTLY AS IT APPEARS ON THE INSTRUMENT. Please have your signature
witnessed by a separate party.
4. If signing for a corporation, signature must be attested, corporate seal affixed and title of signatory party
shown.
6. If the instrument is signed by an agent, attorney -in -fact, guardian, estate representative, trustee or any party
other than the named interest owner, we must have evidence of the rights vested in the signatory party.
7. If an interest is shown jointly for more than one person, each party must sign the division order in the manner
that his or her name is shown thereon. In the event one party has been designated agent for the joint interest
shown or he/she has been granted a power of attorney for the other party(ies), we must have evidence to this
effect.
8. Insert your Tax Identification Number or Social Security Number, whichever is applicable, in the space
provided. We may withhold payment until such number is received.
9. Confirm the address to which checks are to be mailed. If different, please provide the correct address. You
should notify us promptly of any changes in your mailing address.
10. The number assigned to this property can be found on the front of your division order form. The number will
be used to designate this property on your revenue check. Refer to the property number when corresponding.
I1. Return the executed instrument without delay to the address below. KEEP ONE COPY FOR YOUR
RECORDS.
RETURN SIGNED DIVISION ORDER TO:
NOBLE ENERGY INC.
ATTENTION: MARILYN PEOPLES
1625 BROADWAY, SUITE 2200
DENVER, CO 80202
WITH QUESTIONS OR CONCERNS
REGARDING YOUR DIVISION ORDER
PLEASE CONTACT SANDRA KYLE
DIRECT: (303) 228-4274 FAX: (303) 228-4287
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.
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