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HomeMy WebLinkAbout20082872.tiff KERR-MCGEE OIL ANT S'AS ONSHORE DIVISION ORDER Venture Number: 322102 Property Number: 3032153 Property Name: MAGNESS FEDERAL 14-6 JSND Product: All Products �t .. C�p � WELD COUNTY COLORADO Status: NOT APPLICABLE API 0 5' � 23 -6 22.9Zc C/O BOARD OF COUNTY COMMIS County/State: WELD/ CO 915 10TH STREET Effective Date: DATE OF FIRST SALES Owner Number: RV37471504 - WELD COUNTY COLORADO GREELEY, CO 80631 Interest Amt/Type: 0.00070770 / RI Unit Description: T2N R66W SEC 6: SESW JSND FORMATION - 320 AC SPACING "LAY-DOWN" S2 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) 1 �7.1N. WELD COUNTY COLORADO *Tax ID # 84-6000813 Igsl1.1(;::2 .%\ C/O BOARD OF COUNTY COMMIS **Tax ID # 1: i l� • -1//, 1 Ir2—// 915 10th Street At • st : C ,:� \� Owner Signature/Corporate Title Owner Address (if different from above) William H . Jerke , Chair Greeley , CO 80631 By : Deputy"Clerk to Bd Owner Signature/Corporate Title City, State Zip Code 10 / 27 / 2008 970-356-4000 X4200 Owner Daytime Phone • * Failure to furnish your Social Sccurity/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-MCOEE OIL AND GAS ONSHORE Date Prepared: October 10, 2008 1099 18th St. Suite 1800 Prepared by: Tena Murphy Denver, CO 80202-1918 --- 1-800-677-5603 C , S7'Ke R& 2008-2872 / . (-0 .. Consent- /9fy!tdet. l _ w KERR-MCGEE OIL & GAS ONSHORE LP 1099 18TH STREET • DENVER, COLORADO 80202 720-929-6000 k'i KerrNrGee INSTRUCTIONS FOR EXECUTION OF OIL AND GAS DIVISION ORDER 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 completed and signed the Division Order, please return the original to us. The copy is for your records. Should you have any questions, please do not hesitate to call. TENA MURPHY, DIVISION ORDER ANALYST KERR-MCGEE OIL & GAS ONSHORE LP A SUBSIDIARY OF ANADARKO PETROLEUM CORPORATION 1099 18TH ST DENVER CO 80202 (720) 929-6000 A SUBSIDIARY OF ANADARKO PETROLEUM CORPORATION 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: k ny////7 '(1/l[ CouAttofney DATE: /7 - l t J Hello