HomeMy WebLinkAbout20051430.tiff 0 L AND GAS DIVISION ORDEE
OPERATOR: KERR-MCGEE ROCKY MOUNTAIN CORPORATION Date: April 18,2005
1999 BROADWAY,SUITE 3600 Effective Date: Date of First Production
DENVER,CO 80202 Well Number: 921071
(303)296-3600
Well Name: HSR-FRENCH 16-34
Description: T4N-R66W,SECTION 34: SESE
Formation: J SAND/DAKOTA
County and State: WELD COUNTY,COLORADO Copy for your files
Owner: Address: Decimal Interest:
WEL210 915 10TH STREET 0.00568182 RI
WELD COUNTY BOARD OF GREELEY,CO 80632
COMMISSIONER
The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by Kerr-McGee Rocky
Mountain Corporation.
Kerr-McGee Rocky Mountain Corporation shall be held harmless in the event of, and is hereby released from any and all damage or loss which
might arise out of any overpayment or underpayment. The Owner executing this Division Order, in consideration of payments by Kerr-McGee Rocky
Mountain Corporation, agrees to pay any overriding royalty or royalty owners and/or all other persons who may have right, title or interest in the
interest in production set out above and further agrees to protect, indemnify and hold Kerr-McGee Rocky Mountain Corporation harmless from and
against any and all loss, cost or expense which it may suffer or sustain by reason of such payment regardless of how any such claim or demand may
arise, including all costs or expenses incurred by Kerr-McGee Rocky Mountain Corporation in defending its position in any such claim,suit or action.
The undersigned agrees to notify Kerr-McGee Rocky Mountain Corporation, 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 Rocky Mountain Corporation.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 Kerr-McGee Rocky Mountain
Corporation any amount attributable to an interest to which the undersigned is not entitled.
Kerr-McGee Rocky Mountain Corporation may accrue proceeds until the total amount equals twenty-five dollars($25.00),or pay annually,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 Kerr-McGee Rocky Mountain Corporation may have certain
statutory rights under the laws of the state in which the property is located.
The undersigned authorizes Kerr-McGee Rocky Mountain Corporation to withhold from the proceeds of any and all production referred to herein the
amount of any tax placed thereon by any governmental authority and to pay the same on our behalf.
Cfi/ s/ tteo
Owner(s)Signature(s): )
William H. Jerke, Chair Clerk to the Board
Owner(s)S.S.or Tax I.D.# 84-6000-813 05/09/2005 'ear`ie. r ` /
40011,
WNl e k to the Board
.a: ��
Owner Daytime Telephone# (970) 356-4000 X4200 11861 �� 51, �a =,
o •4 �'
Owner Fax Telephone# (970) 352—0242 ,P® mow
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0°' Federal Law requires you to furnish your Social KMG USE O
Security or Taxpayer Identification Number. Rec'd by Date:
Failure to comply will result in 31%tax Rels'd by Date: LE o withholding and will not be refundable by Payer
Approv'd by Date:
Kiii KERR-MCGEE ROCKY MOUNTAIN CORPORATION
1999 BROADWAY•SUITE 3600•DENVER,COLORADO 80202
PHONE:303/2963600
April 18, 2005 FAX:303/296-3601
WELD COUNTY BOARD OF COMMISSIONER
915 10TH STREET
GREELEY, CO 80632
RE: Suspended Owner - Division Orders
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 you
files of Division Order(s) covering your interest for you to execute so that we can release the
revenue of$14,866.55 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.
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.
Yours truly, S
Saundra Thompson
Senior Administrative Assistant
/set
ends.
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 ofalties, if applica
BY:
Co Attorney
DATE:
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