HomeMy WebLinkAbout20091759.tiffKERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
WELD COUNTY COLORADO
C/O BOARD OF COUNTY COMMIS
915 10TH STREET
GREELEY, CO 80631
Venture Number: 322416
Property Number: 3009207
Property Name: GETZ HELMER UNIT 1 SUSX
Product: All Products
Status: NOT APPLICABLE
County/State: WELD/ CO
Effective Date: DATE OF FIRST SALES
Owner Number: RV37471504 - WELD COUNTY COLORADO
Interest Amt/Type: 0.00003763 / RI
Unit Description:
TIN R66W SEC 18 SWSW
SUSSEX FORMATION 160 AC SPACING SEC 18: SW
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)
ATTEST:
WELD COUNTY COLORADO *Tax ID # 84-6000813
LUJ6L4
C/O rARD OF COUNTY COMMIS •'Tax ID #
— G1 Cl- k to t • Boa ld Owner Signature/Corporate Title
BY:
Deputy Cle
William F. Garcia, Chair
Owner Signature/Corporate Title
JUL 2 9 2009
Owner Address (if different from above)
City, State Zip Code
970-356-4000 X4200
Owner Daytime Phone
DF
07/q6ci 4,67/9-,f
* Failure to furnish your Social Security/Tax ID number will result in withholding tax in accordance with federal law and any tax withheld w"
**Insert Tax ID number for all individual parties listed above in the Name and Address box
2009-1759
Return to
KERR-MCGEE OIL AND GAS ONSHORE
P.O. Box 173779
Denver, CO 80217-3779
I -800-677-5603
Date Prepared. June 18, 21)09
Prepared by: TENA MURPHY
O7/3o/o9
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 changes 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 Changes 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 Changes: 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 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: httos://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.
DATE. / _�7
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.
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