HomeMy WebLinkAbout20092477.tiffKERR-MCGEE OIL AND GAS ONSHORE
DIVISION ORDER
WELD COUNTY BOARD OF COMMISSIONER
915 10TH STREET
GREELEY, CO 80632
Venture Number: 461737
Property Number: 3007186 / 00001
Property Name: BARCLAY-CRISMAN 2-4-20 JSND
Product: All Products
Status: NOT APPLICABLE
County/State: WELD/ CO
Effective Date: DATE OF FIRST SALES
Owner Number: RV37471404 - WELD COUNTY BOARD OF COMMISSIOF
Interest Amt/Type: 0.01562500 / RI
Unit Description:
T3N-R66W SEC 20: S/2NW/4, N/2SW/4
SPACING 160 ACRES MTh
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)
WELD COUNTY BOARD OF COMMISSIONER *Tax ID # 84-6000813
Owner Sigrt6ture/Corporate Title 09/16/2009
William F. Garcia, Chair
Board Owner Signature/Corporate Title
**Tax ID #
Owner Address (if different from above)
City, State Zip Code
Owner Daytime Phone
00 Wcpk(O6G- 09 47/
* Failure to furnish your Social Security/Tax ID number will result in withholding tax in accordance with federal law and any tax withheld will not be refundable by payor.
**Insert Tax ID number for all individual parties listed above in the Name and Address box
Return to: KERR-MCGEE OIL AND GAS ONSHORE
P.O. Box 173779
Denver, CO 80217-3779
I-800-677-5603
Date Prepared: September 01, 2009
Prepared by. SAUNDRAT1-I�ONJP,SON by '77
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Kerr-McGee Oil & Gas Onshore LP
KerrNtGee
September 1, 2009
Dear Interest Owner:
1099 18th Street, Suite 1800
Denver, CO 80202-1918
P.O. Box 173779
Denver, CO 80217-3779
720-929-6000
RE: Money Held in Suspense
Our records indicate that you are an interest owner in a Kerr McGee Oil and Gas Onshore LP
operated well(s). A Division Order was previously sent to you requesting you to review the
information, sign and return to us. Because we did not receive the signed Division Order back
from you, your interest is in suspense. For us to release that money we must have a Division
Order signed by you the interest owner. In order to accomplish this we have enclosed another
Division Order for you to review, sign and return. Once we have received the signed Division
Order, we will be able to release the suspended funds to you. We must have the signed Division
Order returned so we can pay you on the suspended well. If we do not received the signed
Division Order your money will stay in suspense.
If you are no longer the owner of this interest, please return the unsigned Division Order with a
note telling us that you have sold/transferred the interest with the name, a copy of deed or
address.
Please read the following instructions carefully before signing the enclosed division order:
1. Be sure that your interest is correct.
2. Sign your name in the space provided exactly as it is shown BEFORE TWO WITNESSES.
3. Your SOCIAL SECURITY NUMBER or TAX IDENTIFICATION NUMBER must be shown in the
space provided. Failure to provide the number may result in withholding of your production proceeds, as
required by law, and you may also be subject to a penalty imposed by the Internal Revenue Service.
4. Verify the address to which checks should be mailed.
5. If the interest is owned by a CORPORATION, the division order must be signed by a duly authorized
officer and attested. The corporate seal must be affixed and the title of the signing officer shown.
6. If the interest is owned by a PARTNERSHIP, the division order must be signed by the general partner or
managing partner and evidence of such authority to sign must be furnished.
7. If the division order is signed by anyone other than the named owner such as an AGENT, ATTORNEY -
IN -FACT, or GUARDIAN, evidence of authority must be provided.
After you have signed the Division Order, please return the original, with Exhibit A attached, to
us. Please keep the copy for your records. If you have any questions, please call me at 720-929-
6549.
Yours truly,
//
Saundra Thompson
Staff Land Administrative Specialist
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
Attorney
DATE. 9— /51- D q
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