HomeMy WebLinkAbout20083233.tiff KERR-MCGEE OIL AND GAS ONSHORE DIVISION ORDER
Venture Number: 320984
Property Number: 3031699
Property Name: WATADA 11-18A SUSX
Product: All Products
WELD COUNTY BOARD OF COMMISSIONER Status: NOT APPLICABLE
County/State: WELD/CO
915 10TH STREET Effective Date: DATE OF FIRST SALES
Owner Number: RV37471404-WELD COUNTY BOARD OF COMMISSION.
GREELEY,CO 80632 Interest Amt/Type: 0.00007812/RI
Unit Description:
TIN R66W SEC 18:NESW
SUSX FORMATION-80 AC SPACING E2SW
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$100,or Sept.30 whichever occurs first,or as required by applicable
state statute.
This Division Order does not amend any lease or operating agreement between the undersigned and the lessee or operator or
any other contracts for the purchase of oil or gas.
In addition to the terms and conditions of this Division Order,the undersigned and Payor may have certain statutory rights
under the laws of the state in which the property is located.
Note:NADOA Model Form Division Order(Adopted 9/95)
WELD COUNTY BOARD OF COMMISSIONER *Tax ID#84-6000813
**Tax ID#
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ATTEST: �i�► L;" f-� 21-f
C -rk t i t, Ed- Td' -` Owner Signature/Corporate Title Owner Address(if different from above)
BYt ��� �� x, �' William H. Jerke, CHair
Deputy Cle >�'tO ,tl1e-$O• (1 I- Owner Signature/Corporate Title City,State Zip Code
N 970-356-4000 Ext 4200
Owner Daytime Phone
DECj r 2008
e&i'z 4> /' ozef
°Failure to fur 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 I • Date Prepared: October 10,2008
1099 18th Se Suite 18 I00 t. CCr-k. Prepared by: Tena Murphy
Denver,CO 80202-1918 /y
I-800-677-5603 LI- 7V` 5
v /, , / ,--‘7M P•-
KERR-MCGEE OIL& GAS ONSHORE LP 1099 18TH STREET • DENVER, COLORADO 80202
720-929-6000
4'! KerrNtGee
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:
Cou Attorney n �y
DATE:' �G I vo
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