HomeMy WebLinkAbout20091533.tiffDIVISION ORDER
To: Petro -Canada Resources (USA) Inc. Date:
999 D nver,hStreet, Suite CO 80202-1904 600
/7P3 05_O3- t �' p 3Effective Date:
Well Name:
Property Number:
Prospect:
Operator:
County and State:
Property Description:
Production: Oil
Shable 14-23
16190
Weld Cty Leasing Program - P05166
Petro -Canada Resources (USA) Inc.
Weld County, Colorado
June 8, 2009
First Production
RETAIN THIS COPY FOR
YOUR FILE
(DO NOT DETACH EXHIBIT "A")
T7N, R64W, 6th P.M., Section 14: W/NW
X Gas
X
Other
Owner Name and Address:
SEE ATTACHED EXHIBIT "A"
Owner Number: SEE ATTACHED EXHIBIT "A"
Type of Interest SEE ATTACHED EXHIBIT "A"
Decimal Interest: SEE ATTACHED EXHIBIT "A"
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:
Social Security/Tax ID Number(s) 84-6000-813
Daytime Telephone No. 970-356-4000 X4200 ATTEST:
FAX Telephone No. 970-352-0242
William F. Garcia, Ch
01
C
rri
l)i?f //167
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 Payor.
LC
CC '. Pt_ r Pe(
06,
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PETRO-CANADA RESOURCES INC
Attached to and made a part hereof that
Certain Division Order
Effective on Date Shown Herein:
Well/Unit No: 16190 Issue Date:
Well/Unit Name: SHABLE 14-23 Effective Date:
County: WELD Last Change Date:
State: COLORADO D/O Master Ref:
Operator: PETRO-CANADA RESOURCES (USA) I Product:
Original D/0 Date:
From Well Master Tract#: 11310
Well/Unit Description:
W/2NW 14-T7N-R64W
x
05/18/09
First Production
08/01/08
15480
ANY PRODUCT
Owner
Number Taxpayer ID
Owner Name and Address
102098 WELD COUNTY BOARD OF COUNTY
COMMISSIONERS
WELD COUNTY CENTENNIAL CENTER
915 10TH ST
GREELEY, COLORADO 80632
PAGE 1
Type
Interest
Decimal Pay
Interest Code
RI 0.12500000 M
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'.�
County�Attorney
DATE
c.
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