HomeMy WebLinkAbout20041857.tiff • NADOA Model Form Division Order(Adopted 9/95)
DIVISION ORDER
To: EnCana Oil &Gas (USA) Inc.
950 17th Street,Suite 2600 Date: June 15, 2004
Denver, Colorado 80202 Effective Date: June 1, 2003
Property Number: 761460
Property Name: Kats B Unit 2 (N)
Operator: EnCana Oil & Gas (USA) Inc. RI Royalty Interest
County and State: Weld County, CO OR Overriding Royalty Interest
Property Description: Section 34: SWNE (S/2)—T1N-R68W WI Working Interest
Production: ® Oil ® Gas ❑ Other
Owner Name and Address Property# Owner# Interest
See Attached Exhibit"A" 761460 See See Attached Exhibit"A"
Attached
Exhibit"A"
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by
EnCana Oil &Gas (USA) Inc. (EnCana).
EnCana 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.
EnCana 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 EnCana any
amount attributable to an interest to which the undersigned is not entitled.
EnCana 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 EnCana may have certain statutory rights
under the laws of the state in which the property is located.
Special Clause: NONE �(�A _
Owner(s)Signature(s): VVUL
Robert D. Masden, Chair 06/28/2004 COPY
Owner(s) Signature(s):
Owner(s) S.S./Tax I.D. #(s): 84-6000-813 BY:
Y:Deputy, q I Clerk to hroard
WELD COWNT; BOARD
Owner Daytime Telephone#: (970) 356-4000 X4200 ATTEST L
Owner Fax#: (970) 352-0242 WELD CO
' 1861
Federal Law requires you to furnish your Social Security or Taxpayer Identification
Failure to comply will result in 28% tax withholding and will not be refundable by P•
2004-1857
No--22
-U-HAD!Division orders NADOA DO FORM-Kats B Unit 2(N).doc 06/15/04 3:50 PM LE 0 , ✓9 3
C`(` NthlllA il(I-e'l-GLI
a ENCANA OIL 6 GAS (USA) INC
Attached to and made a part hereof that
Certain Division Order
Effective on Date Shown Herein:
Well/Unit No: 761460 Issue Date: 06/15/04
Well/Unit Name: RATS B UNIT 2 (N) Effective Date: 11/01/03
County: BROOMFIELD Last Change Date: First Production
State: COLORADO D/O Master Ref: 27033
Operator: EnCana Energy Resources Inc Product: OIL
Original D/O Date: 06/01/03
From Well Master Tract*: (NONE)
Well/Unit Description:
Owner Owner Name and Address Type Decimal Pay
Number Taxpayer ID Interest Interest Code
2101559 Weld County Colorado Board of County RI 0.00244921 M
Commissioners
P O Box 758
Greeley, COLORADO 80632
PAGE 1
ENCANA..
EnCana Energy Resources Inc.
950 17th Street to (303)623-2300
Suite 2600 fax: (303)623-2400
Denver CO USA 80202
June 15,2004 www.encana.com
TO: INTEREST OWNERS
RE: Kats B Unit 2 (N)
Section 34: SWNE (E/2)—TIN-R68W
Weld County, CO
The captioned well is currently producing from the Niobrara formation. Accordingly, we
are enclosing a new division order for your execution and return. Encana Oil & Gas
(USA) will be disbursing for all oil and gas on this well. If you are currently in a pay
status on existing wells within the same spacing unit (E/2 of Section 34 — T1N-R68W),
Encana will place your interest in the new well/formation in a pay status, however, we
kindly request that you execute the enclosed division order and return it back to this
office at your earliest convenience. Please execute the division order in accordance with
the letter of instruction enclosed.
Should you have any questions or concerns in this regard please do not hesitate to contact
the undersigned. Your prompt cooperation is greatly appreciated.
Sincerely,cEa Oil & Gas(USA)
a.)\(1/4ea
Lisa H. Roy L
Division Order Analyst
/Ihr
ends.
'''Trade-Mark of EnCana Corporation.Used under license.
INSTRUCTIONS FOR EXECUTION
OF OIL AND GAS DIVISION ORDERS
The enclosed Division Order should not be altered in any way except to correct
spelling errors. Unless accompanied by documentary evidence to support the
change. 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 on the division order.
3. Your SOCIAL SECURITY NUMBER OR TAX ID NUMBER must be shown in the
space provided. Failure to provide the number may result in a 28% withholding of
your production proceeds, as required by law, and you also could be subject to a
penalty by the Internal Revenue Service.
4. Show 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 must be
provided.
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. Do not detach the exhibit from the Division Order if one is
included. Should you have any questions, please do not hesitate to call.
LISA H. ROY
ENCANA OIL & GAS (USA), INC.
950 17TH STREET, SUITE 2600
DENVER, CO 80202(303) 623-2300
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, I escription, and
percentage o�ties, if appli
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BY: �/ \ �'7----
Cou Attomery
DATE: I ZI n 1---
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