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RESOLUTION
RE : APPROVAL OF OIL AND GAS DIVISION ORDER REGARDING AMOCO
PRODUCTION COMPANY , P . O . BOX 591 , TULSA , OKLAHOMA 74102
WHEREAS , the Board of County Commissioners of Weld County ,
Colorado , pursuant to Colorado statute and the Weld County Home
Rule Charter , is vested with the authority of administering the
affairs of Weld County , Colorado , and
en o WHEREAS , Weld County , Colorado , is the holder of a certain
go lease with Amoco Production Company . Said lease covers land more
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particularly described as follows , to -wit :
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o Part of the SW% , Section 21 , Township 3
w North , Range 67 West of the 6th P . M . , Weld
o County , Colorado
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w WHEREAS , Amoco Production Company has submitted an Oil and
cc, Gas Division Order on the subjectproperty , and
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41 WHEREAS , Weld County is entitled to a one - eighth royalty
ri interest on production , and
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Lo
r' z WHEREAS , in order to receive said royalty interest , Weld
w County must execute said Division Order , a copy of which is
a) u attached hereto and incorporated herein by reference , and
rel o z
w
WHEREAS , said Division Order has been reviewed by the
° E Weld County Attorney , Thomas O . David , and found to be in order ,
c ) and
w
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w WHEREAS , the Board deems it advisable to approve said
w Division Order on the hereinabove described land .
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cn < NOW , THEREFORE , BE IT RESOLVED by the Board of County Com-
o mi_ ssioners of Weld County , Colorado , that the Oil and Gas Divi -
U a sion Order as submitted by Amoco Production Company be , and
Zhereby is , approved .
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The above and foregoing Resolution was , on motion duly made
ri 0 o and seconded , adopted by the following vote on the 8th day of
w October , A . D . , 1984 .
i ,Avvertkrie BOARD OF COUNTY COMMISSIONERS
� � � WELD COUNTY , COLORADO
ATTEST : ��
Weld C&inty lerk and Recorder EXCUSED DATE OF SIGNING - AYE
and Cl,drk to. the Board Norman Carlson , Chairman
t .
4,ute , , ounty erk ine J • nson , Pro - Tem
/ (APPRO D A _ EOPM : /
c----- � Gen R Bra
Cte47-Coe---zi
County Attorney u Carls n 840C21
L 7�Evo a a- k ! 3_ ) _ z
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Martin
LHR 544 n T . ten V- /c. a./ // , ,,
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r moco Production Company
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Oil and Gas Division Order Pace 1
09-2a-84
Effective At 7 A.M. F IRS-1 PRODUCT ION
Property Name KURTL• ALBERT• SU /C/•—TRUE /URI/
/
Royalty/Product ALL PRODUCTS LPN 646861—
Operator AMOCO PRODUCT ION COMPANY
Field WATTENBLRG FLAC 149028 00 3 00
State CU County/Parish WELD 00 000
Description of Property Special Notes
W/2 SCC.21 3N-67W AS TO GAS AND LIQUID
HYDROCARBONS
B 1046 REC 01984642 10/10/84 16: 10 $0.00 2/003
F 0249 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO
Business Associate Name Type Decimal
Number Int Interest
617000 00 5 AMOCO PRODUCTION COMPANY
10031 X 6.25% URI UNTIL PAYOUT
AMOCO'S URI EXTINGUISHED APO 02 .0625000
7311 00 3 X U EXPLORATION INC 02 .0002375
602816 00 1 CHAMPLIN PETROLEUM COMPANY 04 .0100430
511851 00 8 GREAT WESTERN SUGAR COMPANY 04 .0005938
525778 00 7 KURTZ• ALBERT D 04 .1171640
"765255 00 5 WELL) COUNTY CULUktAoU 04 .0005469
C/U BOARD OF COUNTY COMMISSIONERS
333756 00 5 WATTE.NBERG PARTNERSHIP
100% X 7/8 WI LESS 6.25% URI
LESS ORI 5% X 1 .52/320
PARTNERSHIP CONSISTS OF AMOCO
AND TRUE OIL L.U. TRUE RECEIVES
100% OF PARTNERSHIP INCOME BPU
LESS AMOCO' S ORI
APO AMOCO 91X OF PARTNERSHIP
INCOME* TRUE 9X
AMOCO'S ORI EXTINGUISHED APO
WATTENBERG PARTNERSHIP
AGREEMENT: CONTRACT. 107990 05 .8089148
1 .0000000
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Type Interest Legend.
01 - Working Interest O2 •. Overriding Royalty 03 - Production Payment 04 - Royalty Interest
Form 899 1-77
Oil and Gas Division Order
To: Amoco Production Company
P.O. Box 591,Tulsa, Oklahoma 74102
Each of the undersigned OWNERS guarantees and warrants he is the owner of the interest set out opposite his name on the reverse side
hereof in oil and gas or the proceeds from the sale of oil and gas from the property described on the reverse side hereof,and until further
written notice either from you or from us,the undersigned owner and all other parties executing this instrument hereby authorize you,your
successors or assigns to receive and measure such sales in accordance with applicable governmental rules and regulations and to give credit
as set forth on the reverse side hereof.
The following covenants are parts of this instrument and shall be binding on the undersigned, their successors, legal representatives,and
assigns:
Oil: Oil sold hereunder shall be delivered f.o.b.to the carrier designated to gather and receive such oil,and shall become your property
upon receipt thereof by the carrier designated by you or by any other purchaser to whom you may resell such oil.The term"oil"as
used in this division order shall include all marketable liquid hydrocarbons.
Should the oil produced from the herein described land be commingled with oil produced from one or more other separately owned
tracts of land prior to delivery to the designated carrier,the commingled oil sold hereunder shall be deemed to be the interest of the
undersigned in that portion of the total commingled oil delivered which is allocated to the herein described land on the basis of lease
meter readings or any other method generally accepted in the industry as an equitable basis for determining the quantity and quality
of oil sold from each separately owned tract. Such formula shall be uniformly applied to all owners of an interest in the tracts of land
involved.
Should the interest of the undersigned in the oil produced from the herein described land be unitized with oil produced from one or
M O more other tracts of land, this instrument shall thereafter be deemed to be modified to the extent necessary to conform with the
CO ti applicable unitization agreement or plan of unitization,and all revisions or amendments thereto, but otherwise to remain in force and
o effect as to all other provisions. In such event,the portion of the unitized oil sold hereunder shall be the interest of the undersigned
in that portion of the total unitized oil delivered which is allocated to the herein described land and shall be deemed for all purposes
M O to have been actually produced from said land.
U You agree to pay for the oil sold hereunder at thepriceposted g by you for oil of the same grade and gravity in the same producing
o field or area on the date said oil is received by you or the designated carrier. If you do not currently post such a price,then until
O W such time as you do so, you agree to pay the price established by you.You are authorized to reduce the price by those truck, barge,
o ,3 tankcar, or pipe line transportation charges as determined by you.
Should the oil sold hereunder be resold by you to another purchaser accepting delivery thereof at the same point at which you take
o p; title, you agree to pay for such oil based upon the volume-computation made by such purchaser and at the price received by you
tn. W for such oil, reduced by any transportation charges deducted by such purchaser.
Ca Quality and quantity shall be determined in accordance with the conditions specified in the price posting.You may refuse to receive
O any oil not considered merchantable by you.
O
U Gas: Settlements for gas shall be based on the net proceeds realized from the sale thereof, after deducting a fair and reasonable charge
for compressing and making it merchantable and for transporting if the gas is sold off the property.Where gas is sold subject to
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regulation by the Federal Power Commission or other governmental authority,the price applicable to such sale approved by order of
such authority shall be used to determine the net proceeds realized from the sale.
co Settlements: Settlements shall be made monthly by.check mailed to the respective parties according to the division of interest herein
P4 specified at the latest address known by you, less any taxes required by law to be deducted and paid by you applicable to owner's
interest.
• Evidence of Title: The oil and gas lease or leases, and any amendents, ratifications, or corrections thereof, under which said gas and/or oil
m o is produced are hereby adopted, ratified, and confirmed as herein and heretofore amended. In the event any dispute or question
arises concerning the title to the interest of the undersigned in said land and/or the oil or gas produced therefrom or the proceeds
0 2 thereof, you will be furnished satisfactory abstracts or other evidence of title upon demand. Until such evidence of title has been
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furnished and/or such dispute,defect,or question of title is corrected or removed to your satisfaction, or until indemnity satisfactory
o E to you has been furnished, you are authorized to withold the proceeds of such oil or gas received and run, without interest.In the
r--I cn event any action or suit is filed in any-court affecting the title to the interest of the undersigned in the herein described land or the
oil or gas produced therefrom or the proceeds thereof to which the undersigned is a party,written notice of the filing of such suit or
111
N action shall be immediately furnished you by the undersigned,stating the court in which the same is filed and the title of such suit or
W action.You will not be responsible for any change of ownership in the absence of actual notice and satisfactory proof thereof.
W Contingent Interests: Whether or not any contingency is expressly stated in this instrument,you are hereby relieved of any responsibility for
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determining when any of the interests herein shall increase, diminish,terminate, be extinguished or revert to other parties as a result
rn z of the completion or discharge of money or other payments from said interest, or as a result of the expiration of any time or term
'-I limitation(either definite or indefinite), and, unless you are also the operator of the property, as a result of an increase or decrease in
o production,or as a result of a change in the depth,the methods or the means of production,or as a result of a change in the allocation
91 of production affecting the herein described land or any portion thereof under any agreement or by order of Governmental authority,
t4 P4 and untilyou receive notice in writing to the contrary,you are hereby authorized to continue to remit without liability pursuant to the
division of interest shown herein.
Warranties: Working Interest Owners and/or Operators,and each of them, by.signature to this instrument,certify,guarantee and warrant,
L O for your benefit and that of any pipe line or other carrier designated to run or transport said oil or gas,that all oil or gas tendered here-
o N under has been and shall be produced from or lawfully allocated to the herein described land in accordance with all applicable Federal,
O state and local laws,orders, rules and regulations.
This instrument may be executed by one or more, but all covenants herein shall be binding upon any party executing same and upon
his heirs,devisees,successors,and assigns irrespective of whether other parties have executed this instrument.
Weld County, Colorado
Board of Commissioners
,j,
*taut (2 1—1 / ���' J-� P n lime 7 SR
Witness of S alurree Name / Street or Box No.
°_ ` � re Greeley, CO 80632
`-�, ( J City,Slate.Zip
uI/�Zy1.x P_ �lLtoy.-�c- �/
(fitness of Signature ^1C-L0--ft,
_ , Street or Box No.
City,State,Zip
Witness of Signature N r ' )974 �,/ Street or Box No.
84-6000813
Social Security for Tax ID)Number City.State.Zip
/,d i� zv d t t.J� io `51� , 110O-tt+l`-, ��
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AMOCO Amoco Production Company
_�— Amoco Building
P.O. Box 591
Tulsa. Oklahoma 74102
QUALIFIED ROYALTY OWNER'S EXEMPTION
Owners who may qualify for exemption from Crude Oil Excise Tax (commonly
referred to as Windfall Profit Tax) .
The Economic Recovery Tax Bill of 1981 provides that beginning in 1982 and
in subsequent years, specified amounts of a qualified royalty owner's royalty
production are exempt from crude oil excise tax. The amount of exemption is
two barrels per day for 1982 through 1984 and three barrels per day for 1985
and thereafter.
For you to take advantage of this exemption, you must certify to the purchaser
(or other withholding agent) by using IRS Form 6783. This Certification Form
(6783) requires that you certify under the penalties of perjury, on a property
by property basis, each property that you want the exemption applied to.
Enclosed is a copy of Form 6783 so that you may review the instructions and
determine if you can qualify for the exemption. If you determine that you
meet the three conditions to qualify, as provided in the instructions for
Form 6783, please complete and sign the form and date it or we cannot accept
it as a valid certification.
Please notice that Form 6783 includes a provision for revocation of a
previously filed certification under Part B. If you should determine that
you are no longer able to certify your production from a property, then you
must send Amoco a completed Part B revoking the specific property(ies)
previously certified.
Any new properties that may begin production at a later date will also require
a supplemental certification on Form 6783 in order for Amoco to exempt your
interest from the tax.
If you qualify, please return the completed certification form in the enclosed
return envelope along with your executed transfer order or division order.
Questions you may have concerning the completion of IRS Form 6783 should be
directed to the following address or phone number:
Amoco Production Company
P. 0. Box 591
Tulsa, Oklahoma 74102
(Attention: Compliance Coordination Group)
Telephone Number: (918) 581-3223
Ta, Amoco Production Company
AMOCO: PAYER'S REQUEST FOR TAXPAYER IDENTIFICATION NUMBER
7b525005 149028003 0000000 CRV013
B.A. Code:
WELD COUNTY COLORADO
C/O UOARD OF COUNTY COMMISSIONERS Payee Class:
WELD COUNTY COURT HOUSE For APC Use Only
W P O BOX 758
GREELEY . COLORADO. 80631 nts to furnish taxpayer identification numbers to
vice. For each failure to furnish a taxpayer identifi-
can show such failure is due to reasonable cause and
not to willful neglect.
In addition, effective January 1, 1984, the Internal Revenue Code requires a payer to withhold from payments a tax equal
to 20% of such payments where a correct taxpayer identification number has not been furnished. Amoco Production will
comply explicitly with the withholding provision of the code.To assist you in complying with the law, please complete the
three items shown below and return the entire form immediately to Amoco Production Company. (See reverse side for
guidelines.)
1. TAXPAYER IDENTIFICATION NUMBER (Complete only one per addressee):
To Be Filled in By Person Receiving Payment
Social Security No.
or - J -
Employer Identification No. 8 4 6 1 0 0 0 8 1 3
IApplied for and signed below under
penalties of perjury that taxpayer has
applied for and is awaiting Taxpayer
Identification Number.
2. TYPE OF PAYEE DATA (Check only one) 3. NATURE OF BUSINESS WITH AMOCO
(Check only one for bracketed types)
Individual Providing Health and Medical Care.
Sole Proprietorship Basically providing other services (even though
P p some goods may be provided).
Partnership Basically providing goods(even though some
services may be provided incidentally).
IEstate 1 None of the above applies, but amounts are received
Li Trust X from Amoco for rental, bonus,and/or royalty
payments.
Corporation Providing Health N/A
Care and Medical Services
Corporation (Other)
N/A
Federal, State, or Local N/A
X Government or Agency thereof
L] Tax Exempt Organization N/A
Employee of Standard Oil Co. (Indiana),
Amoco Production Co. or other subsidiary
company
)7f"ge•A"----
1 Nonresident Alien
Signature of Person Preparing Form
4. Return form as indicated below:
Amoco Production Location
A. Vendors and Contractors-Attach to and Requesting Payee's TIN No.
submit with your initial invoice. If this is
not possible,complete immediately and Employee Name:
return to the Amoco Production office
which will be processing your invoice.
Department:
B. Royalty Payees- Return with signed
division order. Location:
C. Rental and Bonus Payees- Return as
requested by payer. For APC Use Only
D. Employee- Return to Supervisor,
Data Control.
Form 1292 MAR-84
•
pp^n 6458(Ray, aaaeemeer t//3) Certification and Election Form cc S. 1W-0210
Wow N3d-0
pewterd tta Treewrr DP See separate instructions. -
madDeeae+e inn Tusmer keefttRySle number
Name 84-6000813
Weld County, Colorado-Board of Commissioners
Address (number and street)
P.O. Box 758
City or town, State and ZIP code
Greeley, CO 80632 I taxpel er Identifying number
of puitlasar (wiry completed by a purchaser who is forwarding a qualified disburser election)
ayaf,W Exemption Certificate
I certify that all my production from the properties on the attached list is exempt from the windfall profit tax.
I am entitled to this exemption because I qualify for the status indicated below(check applicable box):
Q Qualified governmental interest(section 4994(a)) Exempt Indian oil(section 4994(d))
Qualified charitable interest(section 499.4(b)) Qualified independent producer of exempt stripper well oil (section
__O ifs)_ #eil removed after 1912) - --
I understand that I must file Part III within 10 days after I no longer qualify for exemption from the windfall profit tax.
Under penalties of penury.I declare thet I have examined this certificate, including accompanying instruction. and to the best of my knowledge and
belief. it Is true, correct. and complete. /J
Chairman, Board of Commissioner sfia�- - ✓O�P/PSG
� pate losliming,. of exempt producer le /Lv`.
Part?iO.s Independent Producer Certificate
I certify that I qualify as an independent producer as defined in section 4992, and that all my taxable production from the prop-
erties listed on the attached sheet is entitled to the lower rate of windfall profit tax for tier one end tier two oil.
w certified)does not
The total taxable production from these properties (plus production from other qualified property
that exceed my share of the 1,000 barrel a day amount for Independent producers.
I certify that (check applicable box):
I am a member of a related group (as defined in section 4992(e)(2)). I ant attaching a list to the Form 6458 that I am filing with
• the IRS showing the name and taxpayer identifying number of all other members of my "related group."
O I am not a member of a related group (as defined in section 4992(e)(2)).
I understand that I must file Part III within 10 days after I no longer qualify as an Independent producer.
Under*enema of penury. I declare that I liege examined the certficate. ,nciudine accompanying ,netructlene. and to tna beet of my knowledge and
belief, it is true. correct. and complete.
Data re.Signatureof independent producer la
Partin ,. Revocation of a Previously Filed Certificate
I no longer qualify for exemption from, or reduced rates of, the windfall,Qualified irofit ndep The endent ds status
producer that
I previously of exempt claimed stripper well s oil
D Qualified governmental interest ❑ Independent producer � Q
❑ Qualified charitable interest ❑ Exempt Indian oil
Date of original certification ► Service Center where flied ►
Effective date of revocation P.
Data losignatureof producer
Qualified Disburser Election
I certify that I am a qualified disburser as defined In regulations issued under section 4995 and that I hereby elect to perform all the
duties normally imposed upon the purchaser in regard to the administration of the windfall profit tax.
I understand I must file Part VI within 10 days after this election is terminated.
Effective date of election
ProcertY (+ncuda full Noe nary_ ',cation, and identifying number, if applicable)
Date
' Signature of pu Ph� a O O isbu nor
For Paperwork Reduction Act Notice, see page 1 of the instructions.
363-475-i Form 6458 (Rev. 9.42)
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