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Home My WebLink About20033460.tiff -L. will_ AND GAS DIVISION ORDI OPERATOR: KERR-MCGEE ROCKY MOUNTAIN CORPORATION Date: October 23,2003 1999 BROADWAY,SUITE 3600 Effective Date: Date of First Production DENVER,CO 80202 Well Number: 655461 (303)296-3600 Well Name: William#2 Description: T3N-R66W,Section 18: W'/2 Formation: J Sand County and State: Weld County,Colorado Owner: Address: Decimal Interest: WEL225 c/o Board of Cnty Commis. 0.00042244 ROYA Weld County Colorado P 0 Box 758 LTY Greeley CO 806320758 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. Owner(s)Signature(s). r t. he . ,4 ° r David E. Lon , Chair (11/26/03) Deputy Cl r. Owner(s)S.S.or Tax I.D.# 84-6000-813 Owner Daytime Telephone#____C270 356-4000 X4200 Owner Fax Telephone# (970)352-0242 Federal Law requires you to furnish your Social Security or Taxpayer Identification 2003-3460 Failure to comply will result in 31%tax withholding and will not be refundable by ; a-t< ©in KERR-MCGEE ROCKY AMOUNTAIN CORPORATION 1999 BROADWAY.SUITE 3600 • DENVER. DO 80202 - PHONE: 303-296-3600 FAX: 303-296-3801 INSTRUCTIONS FOR EXECUTION OF OIL AND GAS DIVISION ORDERS 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 ta•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. ERIN J. LANGDON KERR-MCGEE ROCKY MOUNTAIN CORPORATION 1999 BROADWAY, SUITE 3600 DENVER, CO 80202 (303) 296-3600 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 applicabl BY: , ) - County ey DATE: / II l I c°—j Hello