HomeMy WebLinkAbout20082745.tiff Colton LLC
NADOA Model Form Division Order (Adopted 9/95)
OWNER: Weld County Colorado
915 10th Street
Greeley, CO 80631
Effective Date: First Production
Prospect Name: Evans
Property Name and Number: Camenisch-Dos Rios 16-33B
Operator: Colton LLC
County and State: Weld County,Colorado
Property Description: Township 05 North, Range 66 West 6th P.M. "J"Sand Formation Only
Section 33: E/2SE/4
Section 34: W/2SW/4
Weld County,Colorado
Production: Oil: Gas: X Other:
Type of Interest: Royalty Interest
Decimal Interest: 0.00341707
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Colton
LLC(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 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 in which the undersigned is not entitled.
Payor may accrue proceeds until the total amount equals$25,or pay annually,if amounts are greater than$5,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 and/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: if applicable,see attached Exhibit. s
Owner(s)signature(s): Witness or Attest: �/��!/v
r\--vit6Ci-A-N ATTEST:
Cl 2rk, to B rd /jt r r.
William H. Jerke, Chair BY:
10/13/2008 Deputy Cl rk to the Board
Owner(s)Tax I.D. Number(s): 84-6000-813
Owner(s) Daytime Telephone#: 970-356-4000
Owner(s) Fax Telephone#: 970-352-0242
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.
2008-2745
621 17TH STREET,SUITE 1520,DENVER,COLORADO 80293 m(303)297-0347 4?FAX(303)297-9075
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