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Home My WebLink About20073695.tiff NADOA Model Form Division Order(Adopted 9/951 KERR-MCGEE OIL & GAS ONSHORE LP DIVISION ORDER 1999 BROADWAY SUITE 3700 DENVER CO 80202 Property Number: CO15057.0/3003398 Today's Date: October 23, 2007 Effective Date: Date of First Production Property Name: MILLER FFDFRAI 1Q-6 Prospect: CODELL Operator: KERR-MCGEE OIL &GAS ONSHORE LP County/State: WELD, CO Pi 05, 12 3 -.2.18q g Description: TQWNSHIP 2 NORTH, RANGE 66 WEST 11 SECTION 6' NWSE Production: DTI Oil Gas DTI Other: Owner Name: WELD COUNTY BOARD OF COMMISSIONER Owner Number: RV37471404 Address: 915 10TH STREET Interest Type: RI GREELEY, CO 80632 Decimal Interest: 0.00142190 Kerr-McGee 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. Kerr-McGee is authorized to withhold payment pending resolution of a title dispute or adverse claim asserted regarding interest in production claimed herein by the undersigned. The undersigned agrees to indemnify and reimburse Kerr-McGee any amount attributable to an interest to which the undersigned is not entitled. Kerr-McGee may accrue proceeds until the total amount equals$100.00, or pay annually, whichever occurs first, or as required by applicable state statutes. 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 Kerr-McGee may have certain statutory rights under the laws of the state in which the property is located. Special Clause: This Division Order may be executed in any number of countprparts with the same force and effect as if all the parties had signed the same sheet of paper, and is effective regar hether all parties owning an interest in the royalty, mineral estate or leasehold estate execute this Division Order. .,. gg Owner Signature: �i r : /11)42 CY; I syS `� David E. Long, Chair 12/ �/2 ��t'' ' rk to the Board Owner Tax ID, SS# 84-6000-813 '-ay,, it) e ty Cl k to the B and Telephone Home owner Fax 970-352-0242 Work 970-356-4000 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 Kerr-McGee. Your Copy Lr ©o9a is/o/o ec : 14g/2 n 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, le I description, and percentage of royaltts, if applicab BY: Cou Attorney•� i _ DATE: / i I kill KerrNtGee Kerr-McGee Oil 8 Gas OnShore LP October 23, 2007 1999 Broadway,Suite 3700,Denver,Colorado 80202 303-296-3600•Fax 303-296-3601 WELD COUNTY BOARD OF COMMISION 915 10'tt STREET GREELEY, CO 80632 RE: Suspended Owner - Division Order In reviewing our records we noticed that your interest has been in suspense because we do not have an executed Division Order(s) from you. Enclosed are one original and one copy for your files of Division Order(s) covering your interest for you to execute so that we can release the revenue of$773.10 that we have in suspense. Please read the following instructions carefully before signing the enclosed division order: 1. Be sure that your interest is correct. 9. 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. Yours truly, ioLky tk— Cara Pedigo Contract Assistant /set ends. 2007-3695 1 C(r(* Hello