HomeMy WebLinkAbout20051616.tiff d750921/JMO fit
2618/026450/0221176
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DIVISION ORDER
,
To: Plains Marketing,L.P. Owner Number
P.O.Box 4648 0221176
Houston,TX 77210-4648 Date: 05/17/2005
Property Descr: SEE EXHIBIT'A' Property Number.
Property Name: PRONGHORN 14-4 Effective 7 A.M.: 02/01/2005
01 126255
Operator: CFG
County and State: WELD, CO Decimal Interest. 0.06250000
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
P OBOX 758 i P O 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 oy 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 shah.be effective the first day of the month following receiptnot c
Payor is authorized to withhold payment pending resolution of a title dispute or adverse claim asserted regarding the interest in production cP ed ne e,n oy he undersignea T Pe uoCersignec agrees y
reimburse Payor any amount attributable to an interest to which the undersigned is not entitled. Unless otherwise required by'a be -Payor shall _tqu. m red to •oteres,or payments++ tte a d c
a title dispute or adverse claim.
Payments of less than$25 O0 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 0e of 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 ag eeo to by the operator for oil arc o
condensate to be sold pursuant to this division order. Payor shall compute quantity and make corrections for gravity and temperature and make deductions for p ies As to gas tf eroe's
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 sb 'e re a at Me pricy
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 no take title to Ihe gas Toe operator
responsible far marketing gas produced from the property described in the attached properly 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# 6000813
or Taxpayer ID#: 84-6000813
_.Owner Daytime Telephone#: (970) 356-4000 X4200
Owner FAX#: (970) 352-0242 •
Email Address: ����, - ��`
Qt ` ' Signature of two i��� 0) J \
Owner By. ' L., �// , Witnesses/Attest r '
Signature: OWNER #1 0221176 Clerk to the Bo•174 . E
William H. Jerke, Chair 06/01/2005 �,/,
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TITLE Board of County Commissioners 04 �uY efeLk Lu 4i,
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FEDERAL lAW REQUIRES YOU TO FURNISH YOUR SOCIAL SECURITY OR TAXPAYER IDENTIFICATIO ' , I yv�
Il FAILURE TO COMPLY WILL RESULT IN 28%TAX WITHHOLDING AND WILL NOT BE REFUNDABLE BY PAYOR. J
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d750921/JMO/jt
050517000701
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EXHIBIT 'A'
PROPERTY NUMBER: 01 126255
OWNER: 0221176
OWNER NAME/ADDRESS SSN/TIN INTEREST TYPE PAY ST EFFECTIVE CLAUSES REQUIREMENTS
0221176 WELD COUNTY COLORADO 84-6000813 0.06250000 RI 3V 02/01/2005 1 N/A
CIO BOARD OF COUNTY
COMMISSIONERS
WELD CNTY CENTENNIAL CENTER
P O BOX 758
GREELEY,CO 80632
CLAUSES TITLE I THIS DIVISION ORDER APRIL 26,2005 PREPARED S BEEN
EBNER WITHR LOHFE WITH SAIMANAJACOBSION HHYMAND&R OPINION DATED
FEIGER C
LEGAL DESCRIPTION
5/2 SW/4 SECTION 4, TOWNSHIP 5 NORTH,
RANGE 61 WEST, 6TH P.M. , WELD COUNTY,
COLORADO.
Page 1 (Exhibit A)
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 appliyab1
�'/"
BY: ,
Co Attorney
DATE: ; / -7`'`411/ 1---r/1�
d750921 I JMO Ip
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
UNLMPLY WITH THESE INSTRUCTIONS WILL DELAY PAYMENT. THE ESS ATTACHED DIVISION ORDER SHOULD NOT BE ALTERED IN
ACCOMPANIED BY DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGE
ANY WAY
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.
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