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Home My WebLink About20082390.tiff f DOPRBAT/PB/mea 3050/026450/0221176 ( KEEP THIS COPY FOR YOUR RECORDS) HO IIII IIII IIitl111 IIII 0O HHHWH H DIVISION ORDER To: Plains Marketing, L.P. Owner Number P.O. Box 4648 Houston, TX 77210-4648 Date: 07/28/2008 0221176 Property Descr: SEE EXHIBIT'A' Property Name: DOS RIOS 12-34A Effective 7 A.M.: 03/01/2008 Property Number: Operator: COLTON LIMITED LIABILITY CO 01 155317 County and State: WELD, CO Decimal Interest: 0.00541786 Production: OIL/CONDENSATE(GAS) Type of Interest: RI ROYALTY INTEREST Owner Name WELD COUNTY COLORADO WELD COUNTY COLORADO and Address: C/O BOARD OF COUNTY C/O BOARD OF COUNTY COMMISSIONERS COMMISSIONERS WELD CNTY CENTENNIAL CENTER WELD CNTY CENTENNIAL CENTER PO BOX 758 PO BOX 758 GREELEY, CO 80632 GREELEY, CO 80632 [Correspondence Address] [Remittance Address] The undersigned severally and not jointly certifies the ownership of their decimal interest in production or proceeds as described above payable by Plains Marketing,L.P.(hereinafter called"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 tilts dispute or adverse claim asserted,egarding the interest in production clsi aed herein by the undore,gned. The undersigned agrees to reimburse Payor any amount attributable to an interest to which the undersigned is not entitled. Unless otherwise required by law,Payor shall not be required to pay interest on payments withheld due to a title dispute or adverse claim. Payments of less than$25.00 may be accrued before disbursement until the total amount equals$25.00 or more,or until December 31 of each year,whichever occurs first. 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. The undersigned will be paid in accordance with the division of interests set out above. As to oil and/or condensate,the Payor shall pay all parties at the price agreed to by the operator for oil and/or condensate to be sold pursuant to this division order. Payor shall compute quantity and make corrections for gravity and temperature and make deductions for impurities. As to gas,the undersigned will be paid in accordance with the division of interest set forth herein. The Payor will pay all parties for their respective interest in the gas proceeds paid to Payor by the operator for disbursement at the price and upon the terms agreed to by the operator for the gas marketed by the operator. Payor is a disbursement service provider only and does not purchase the gas nor take title to the gas. The operator is responsible for marketing gas produced from the properly described in the attached property description. Payor does not assume any obligations of the lessee or operator under any oil and gas lease, gas sales contract or other agreement to which Payor is not a party. 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/Requirements: If applicable,see Exhibit'A'. Owner Social Security# or Taxpayer ID#: 84-6000813 Owner Daytime Telephone# (970) 356-4000 X4200 Owner FAX ft: (970) 352-0242_ _ • � 1j Email Address'. 7< \jv t! Signature of two A,L6• Owner BY. �/ l Witnesses/Attest Signature: OWNER#: 0221176 SEP 03 2008 William H. Jerke TITLE: Chair, Board of County Commissioners BY• Deputy Cl rk to the l` l FEDERAL LAW REQUIRES YOU TO FURNISH YOUR SOCIAL SECURITY OR TAXPAYER IDENTIFICATION NUMBER. FAILURE TO COMPLY WILL RESULT IN 28%TAX WITHHOLDING AND WILL NOT BE REFUNDABLE BY PAYOR. Coy r on? zee/72 o P P '• PL ti ems ( ( r� :c C") :ellerf- ;e32,0 P DDPRBni'I PB r mea WELD COUNTY COLORADO OWNER NUMBER: 0221176 C/O BOARD OF COUNTY COMMISSIONERS WELD CNTY CENTENNIAL CENTER P O BOX 758 GREELEY,CO 80632 INSTRUCTIONS TO ALL INTEREST OWNERS READ CAREFULLY BEFORE SIGNING DIVISION ORDER. FAILURE TO COMPLY WITH THESE INSTRUCTIONS WILL DELAY PAYMENT. THE ATTACHED DIVISION ORDER SHOULD NOT BE ALTERED IN ANY WAY UNLESS ACCOMPANIED BY DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGE. Signature: Individuals Sign name as shown on the instrument. Have the signature witnessed by at least one person not related to the party signing. Corporations If signing for a corporation,signature must be attested,corporate seal affixed,and title of signatory party shown. If not previously furnished, a certified copy of authority of executing officer must be submitted. Partnerships If signing for a partnership, all partners must sign unless signed by an authorized partner and a certified copy of his authority furnished. Signature by Second Party If the instrument is signed by an agent, attorney-in-fact,guardian,estate representative,trustee or any party other than the named interest owner, evidence of the rights vested in the signatory party must be provided. Taxpayer ID or Social Security Number Insert your number in the space provided. Failure to provide this information may result in backup withholding at the rate of 28%. This information must be shown on this Division Order even if it has been previously provided. State Tax Exempt Please advise immediately if the interest is owned by a tax-free entity and provide our office with a copy of the applicable state form. State taxes will be deducted if you fail to enclose documentation supporting your tax-exempt status. Correspondence Address Indicate in the space provided the address to which correspondence is to be mailed. Print or type. Do not abbreviate. Remittance Address Indicate in the space provided the address to which royalty checks are to be mailed. If you are already receiving checks from Plains Marketing, L.P., be sure to use the same address to which we are now mailing checks. For information about electronic deposit of your check, please call our Customer Relations Department toll free at 1-800-772-7589. Change of Address You should notify us promptly of any change in your mailing address. For your protection, please submit your address change to us in writing at the address below. If you should have any questions, please call our toll free Customer Relations line for assistance at 1-800-772-7589 or in the Houston area at 713-646-4460. RETURN THE EXECUTED DIVISION ORDER AND EXHIBIT'A'PROVIDED TO THE ADDRESS BELOW. KEEP ONE COPY FOR YOUR RECORDS. Plains Marketing, L.P. Attention: Division Order P.O. Box 4648 Houston,TX 77210-4648 PLEASE NOTE THAT AN IMPROPERLY EXECUTED DIVISION ORDER WILL NOT BE PROCESSED FOR PAYMENT AND WILL BE RETURNED FOR PROPER EXECUTION. DOPRBAT/PB/mea 080728000901 ( KEEP THIS COPY FOR YOUR RECORDS) EXHIBIT 'A' PROPERTY NUMBER: 01 155317 OWNER: 0221176 OWNER NAME/ADDRESS SSN/TIN INTEREST TYPE PAY ST EFFECTIVE CLAUSES REQUIREMENTS 0221176 WELD COUNTY COLORADO 84-6000813 0.00541786 RI 53 03/01/2008 1 N/A C/O BOARD OF COUNTY COMMISSIONERS WELD CNTY CENTENNIAL CENTER P O BOX 758 GREELEY,CO 80632 CLAUSES 1 EFFECTIVE 03/01/2008 PRODUCTION, PLAINS MARKETING, L.P. WAS DESIGNATED AS OIL PURCHASER FOR THE DOS RIOS 12-34A LEASE BY THE OPERATOR, COLTON LLC. THIS DIVISION ORDER WAS PREPARED BASED ON INFORMATION PROVIDED BY COLTON LLC. LEGAL DESCRIPTION N/2 SW/4, SECTION 34, TOWNSHIP 5 NORTH, RANGE 66 WEST, 6th P. M. IN WELD COUNTY, COLORADO Page 1 (Exhibit A)) Colton LLC NADOA Model Form Division Order (Adopted 9/95) OWNER: Weld County Colorado Weld County Centennial Center 915 10th Street Greeley, CO 80631 Effective Date: First Production Prospect Name: Evans Property Name and Number: Dos Rios 12-34A Operator: Colton LLC County and State: Weld County, CO Property Description: Township 5 North, Range 66 West Codell and Niobrara Formations Only Section 34: N/2SW/4 Production: Oil: Gas: X Other: Type of Interest: Royalty Interest Decimal Interest: .00541786 / 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 J Owner(s)signature(s): Witness or Attest: ipri �I ,� .1Aw ,} 1,-7 -4j✓ ATTEST: � '�'7 �� '✓" - // ClAr k to th oar William H. Jerke, Chair BY: 449-11-4-b t. SLP 0 3 2008 Deputy Cler( to the Board - Owner(s)Tax I.D. Number(s): 84-6000-813 Owner(s) Daytime Telephone#: (970) 356-4000 X4200 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. 621 17T"STREET,SUITE 1520,DENVER,COLORADO 80293 m(303)297-0347 m FAX(303)297-9075 LEOj7- a,'4W- 423 Colton LLC Dear Owner/Payee: Please review, sign and return the enclosed division order. The purpose of the division order is to provide you information about your ownership and to obtain certification from you that you are the correct person to whom payments for this interest should be made, or that you have transferred your property interest to others. Our division order conforms to the Model Form Division Order endorsed by the National Association of Division Order Analysts and the National Association of Royalty Owners. The following suggestions are made to assist you in completing and returning this division order: + Review the decimal interest in the property described. If you have transferred your property interest your name will appear as the Transferor and the party who received your interest will be listed as Transferee. + Supply and/or verify your Social Security or Tax Identification Number. Without your correct tax identification number, we have to withhold 31% of your payments for the Internal Revenue Service. + Make sure your payment address is correct. + If your name has changed or ownership has changed, please notify us in writing via mail or fax and provide proper documentation (e.g., marriage certificate, divorce decree, deed, will, etc.) Proper documentation is necessary to avoid suspension of your funds. + If you are signing for some other person, please attach documentation (e.g., Power of Attorney). Payments are made upon accrual of$25 for all of the properties paid you by our company or annually, if amounts are greater than $5. Amounts less than $5 are paid either upon accrual after the first year or when we cease paying you for your interests. Should you require payment on a more frequent basis, please contact us and we will remit to you as frequently as provided by State statutes. After you have reviewed the division order, please sign one copy and return to us. The other copy of the division order should be retained for your records. Sincerely, • •i . L�.;. Maria Ray Accountant 621 17T"STREET,SUITE 1520,DENVER,COLORADO 80293 @(303)297-0347 FAX(303)297-9075 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.an BY: yU Coun A�ttorn y U DATE: 7 �� Hello