HomeMy WebLinkAbout20040364.tiff OIL AND GAS DIVISION ORDER
OPERATOR: KERR-MCGEE ROCKY MOUNTAIN CORPORATION Date: January 13, 2004
1999 BROADWAY,SUITE 3600 Effective Date: Date of First Production
DENVER,CO 80202 Well Number: 130750
(303)296-3600
Well Name: OCKER 3-19A
Description: 1N-66W 19 NE/NW SPACING: W/2 -
Formation: J SAND
County and State: Weld County,Colorado
Owner: Address: Decimal Interest:
WEL225 P O BOX 758 0.00052908 GAS RI
WELD COUNTY COLORADO C/O BOARD GREELEY CO 806320758 0.00052908 OIL RI
OF COUNTY COMMIS
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 prbduchert're6erred-to herein the
amount of any tax placed thereon by any governmental authority and to pay the same on our behalf. /
`\,\( Wit l ; • e ' 4i" 4r R
Owner(s)Signature(s):
C rk o e
Robert D. Masden, Chair
(01/26/04) Deputy Clerk to rill
Owner(s)S.S.or Tax I.D.# 84-6000-813
Rec by Date:
Owner Daytime Telephone# (970)356-4000 X4200 Rels'd by Date:
Owner Fax Telephone# (970)352-0242
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 31%tax withholding and will not be refundable by Payer
2004-0364
EXHIBIT "A"
OCKER 3-19A
TOWNSHIP 1 NORTH, RANGE 66 WEST
SECTION 19: W/2
330.76 ACRES, M/L
J SAND FORMATION
WELL # 130750
OWNER MAILING INTEREST DECIMAL INTEREST
NUMBER OWNER NAME ADDRESS CALCULATION INTEREST TYPE
RANDAL GENE DAMIANA AND SANDRA DAMIANA, RT 1 BOX 113 A
DAM414 T/C MOORE, ID 83255-9801 165.36/330.76 AC X 12.5% RI 0.06249244 RI
12486 WELD CO. ROAD 8
DAV515 JOHN C DAVIS FORT LUPTON, CO 80621 51.4/330.76 AC X 12.5% RI 0.01942496 RI
1999 BROADWAY, SUITE 3600
HSR001 KERR-MCGEE ROCKY MOUNTAIN CORPORATION DENVER, CO 80202 0.78917932 WI
1999 BROADWAY, SUITE 3600
HSR001 KERR-MCGEE ROCKY MOUNTAIN CORPORATION DENVER, CO 80202 0.00776998 OR
12236 WCR 8
MCW455 STEVEN S MCWILLIAMS FORT LUPTON, CO 80621 88.2/330.76 AC X 12.5%RI 0.03333233 RI
9885 E 158TH PL.
OCK275 WILLIAM P. OCKER BRIGHTON, CO 80602 24.4/330.76 AC X 12.5% RI 0.00922119 RI
PO BOX 2360
WAT728 TRUE OIL LLC CASPER,WY 82602-2360 0.07805070 WI
PO BOX 758
WEL225 COUNTY OF WELD, STATE OF COLORADO GREELEY,CO 80632-0758 0.14/330.76 AC X 12.5% RI 0.00052908 RI
TOTAL: 1.00000000
Page 1
K�f KERR-MCGEE ROCKY gMOUNTAIN CORPORATION
1999 BROADWAY SUITE 3690 • DENVER, DO 80202
January 13, 2004
RHONE. 303.296-3600
PAX 303-296-3601
RE: Ocker 3-19A
T1N-R66W,Section 19: W''A
Weld County, Colorado
Dear Interest Owner:
In preparation for drilling the subject well, an examination of title to the captioned lands was
conducted. The enclosed Division Order reflects your interest according to the records of Weld
County, Colorado. If you no longer own this interest, please advise.
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 me. The copy
is for your records. Should you have any questions or concerns,feel free to contact me.
Sincerely,
Rebecca A. Bell
Senior Division Order Analyst
enclosures
L� �J//�
•
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 description, and
percentage of alties, if appli e.
BY:
County o euS y
DATE: I I
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