HomeMy WebLinkAbout20083207.tiff IvDIVISION ORDER
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To: Great Western Oil and Gas Company, LLC Date: November 4, 2008
1700 Broadway, Suite 1 170 Effective Date: First Production
Denver, CO 80290
Property Number: 200-00036 & 200-00037 Operator: Great Western Oil and Gas
Property Name: HEINZE 31 -34 & 31 -44 Wells Production: X Oil, X Gas, _ Other
Property Description: S/2 Sec. 31 , T7N-R63W
County and State: Weld County, Colorado
Owner Name: Weld County Board of Commissioners Owner Number: WEL0002
Address: P O BOX 758 Type of Interest: Net Royalty Interest
Greeley, CO 80632 Decimal Interest: 0. 12500000
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above
payable by Great Western Oil and Gas Company, 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 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 reimburse
Payor any amount attributable to an interest to which the undersigned is not entitled.
Payor may accrue proceeds until the total amount equals $25.00, or pay annually whichever occurs first, or as
required by applicable state statue ,
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:
Payor may deduct, in accordance with applicable statutes, ad valorem and severance taxes levied against
this interest and pay the same on our behalf.
Owner or Manager's Signature: Ittirr �
DEC 0 8 2008
Please print name: William H . Jerke r�
Company's Tax ID Number: 800- 813 Ext 4200 qq- �4r I 05- I2 2✓ '24 d1 Telephone: 970-356- 4000
FAX Telephone: 970- 352-0242 r O LJ 2F/�
1 „ ) 1� 2 g
Email: bjerke@co . weld . co . us � � ^ "�j� _� J
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
F ilure to comply will result in 28 % tax withholding and will not be efundable by Payor.
OFFICE SE ONEY LE CO
FOR OFgNNDE O RELEASED FOR PAYMENT BY DATE:_
aeot- i 697
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: 64/ �'.i11t e 1: /-'Z�—�
ig �.._County Attorney
DATE: / 7 3 "ci cY
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