HomeMy WebLinkAbout20051617.tiff Duke
•Energy® GAS DIVISION ORDER
Field Services
Property Number: 575053 Property Township 5 North,Range 61 West
Property Name: PRONGHORN 14-4 Description: Section 4: SW
County and State: Weld,Colorado
Operator: CFG ENERGY INC
Effective Date: January I, 2005
OWNER NUMBER:
See `Exhibit A' attached hereto and made a part hereof Type of Interest:
Decimal Interest:
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Duke
Energy Field Services LP("DEFS")
DEFS 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.
DEFS 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 DEFS any amount attributable to
an interest to which the undersigned is not entitled.
DEFS may accrue proceeds until the total amount equals$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 DEFS may have certain statutory
rights under the laws of the state in which the property is located.
Owner(s) Signature(s):
William H. Jerke, Chair 06/01/2005
Owner(s) Address: 915 10th Street, Greeley, Colorado 80631
Owner(s)Tax I.D./SS#: 84-6000-813
Owner Daytime Telephone 1970) 356-4000 X4200
Owner FAX Telephone#: (970) 352-0242
Z::Zture:
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Witness: i'
Deputy Clerk to
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Federal Law requires you to furnish your So c .I ' axpayer Identification Number.
Failure to comply will result in 28 %tax withho • ng and will not be refundable by DEFS
Return to: Duke Energy Field Services Date Prepared:5/13/05
370 17'"Street,Suite 2500 Prepared by: Libby Ecord
Denver,CO 80202-9732 Direct: 303-605-1896
303-595-3331 („i7l,_/M Fax 303-605-2230
LJ U 2005-1617
te4lta214L?ai�?rt ICJ
Exhibit A
575053 -PRONGHORN 14-4
Owner No. Credit To Type Interest
22031 WELD COUNTY BOARD OF RI 0.06250000<<Your Interest
COMMISSIONERS
219919 DENNIS W. GROTHER LIVING TRUST RI 0.06250000
DTD 2/26/96
171860 CFG ENERGY INC WI 0.87500000
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 applicab
BjAttorney
DATE: ! `i- c----2-1
INSTRUCTIONS TO ALL INTEREST OWNERS
DUKE ENERGY FIELD SERVICES HAS ENCLOSED AN GAS DIVISION ORDER OR TRANSFER ORDER
FOR YOUR EXECUTION. IF YOU ARE RECEIVING A DIVISION ORDER FROM DEFS FOR THE FIRST
TIME, PLEASE BE ADVISED THAT WE ARE THE NEW GAS PURCHASER. IF A TRANSFER ORDER IS
ENCLOSED WE ARE EVIDENCING CHANGES OF OWNERSHIP IN AN EXISTING WELL.
THE ATTACHED DOCUMENT SHOULD NOT BE ALTERED IN ANY WAY EXCEPT TO CORRECT SPELLING
ERRORS, UNLESS ACCOMPANIED BY DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGE.
If your name and interest are correctly shown:
1. Sign your name as shown on the Gas Division Order.
2. Have your signature witnessed by two competent witnesses.
3. If your name has changed due to marriage or divorce, execute the Gas Division Order using your present name and furnish a
copy of the marriage certificate or divorce decree.
4. If signing for a corporation,signature must be attested,corporate seal affixed and title of signatory party
reflected.
5. If signed by agent, attorney-in-fact,guardian or any party other than the named interest owner, a copy of the power of
attorney or other evidence of such party's right to sign must be furnished.
6. Gas Division Orders for partnerships must be executed by all partners or by an authorized partner. A copy of the instrument
giving said partners authority to sign must be furnished.
7. Should you fail to provide your correct Social Security Number or Tax Identification Number, the law
provides that we withhold 28%of all production proceeds due you. You may also be subject to a further
penalty levied by the Internal Revenue Service.
8. Your correct mailing address should be noted in the space provided to insure prompt receipt of production proceeds.
9. The top copy or the"Original"of the Gas Division Order should be returned to:
Duke Energy Field Services
370 17TH Street, Suite 2500
Denver, CO 80202-9732
10. Should you have any further questions regarding the enclosed Gas Division Order please contact your Operator or DEFS at
(303)595-3331.
11. Please DO NOT DETACH the exhibit from the Gas Division Order if one is included.
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