HomeMy WebLinkAbout20090446.tiffNADOA MODEL FORM DIVISION ORDER(Adopted 9/95)
To: Noble Energy, Inc.
1625 Broadway. Suite 2200
Denver, CO 80202
Property Name:
Operator:
County and State:
Property Description:
DIVISION ORDER BC/mp
Date: February 6, 2009
Effective Date: October 16, 2008
Property Number: 435673901
ALLELY J 33-24D (CN)
Noble Energy, Inc.
WELD Co., CO
Township 5 North, Range 66 West, 6'" P.M.
Sec 33: W2SE, E2SW
Production: Gas Oil All X Other
Owner Number: 18032 Owner Name: WELD CO CLERK TO THE BOARD
AT WELD COUNTY GOVERNMENT
Type of Interest: RI Owner Address: PO BOX 758
GREELEY. CO 80632
ecimal Interest: 0.05876563
[he undersigned certifies that ownership of their decimal interest in production or proceeds as described above payable by
Noble Energy, Inc.. hereinafter referred to as "Noble".
Noble shall be notified in writing of any change in ownership, decimal interest, or payment address. All such changes
shall he 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 Payor any
amount attributable to an interest to which the undersigned is not entitled.
Noble may accrue proceeds until the total amount equals $25.00 or pay annually, 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: None
WELD CO CLERK TO THE BOARD
AT WELD COUNTY
GOVERNMENT
Owner(s)Signature(s): q/1� 1
By: William F. Garcia
FEB i 6 2309
Owner(s) SS or Tax I.D. t 84-6000-813
WITNESS(S)
ATTEST:
Cler to the
Deputy Clerk"to the Boa
Owner Daytime Telephone No.:970-356-4000 X4200 Fax No: 970-352-0242
Address: 915 10th Street. P-0. Box 75R, GrPe1Py, Colorado 80632
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 28% withholding and will not be refundable by Noble.
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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 two separate parties.
4. If signing for a corporation, signature must be attested, corporate seal affixed and title of signatory party
shown.
5. If signing for a partnership, all partners must sign, unless signed by an authorized partner and we are
furnished a certified copy of his/her authority.
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.
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 in the upper right corner of the form. The number will
be used to designate this property on your revenue check. Refer to the property number when
corresponding.
II. 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 BONNIE CARPENTER
DIRECT: (303) 228-4407
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•,C1
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