HomeMy WebLinkAbout20010987.tiff DIAMOND SHAMROCK REFINING AND MARKETING COMPANY Page I of I
DIVISION ORDER L97865
Property Number:61073 Date:March 12,2001
Product Type:OIL
Property Name:HAAS#1
State ID:
Operator: SMITH OIL PROPERTIES IN(OP-LT) County and State:WELD,CO
Owner Number:30105466 Analyst: BREWER,LISA
WELD COUNTY BOARD OF
COMMISSIONERS
PO BOX 758
GREELEY,CO 80632-0758
Legal Description:
NE SE SECTION 15-6N-67W,WELD COUNTY,COLORADO
IMPORTANT: You must provide your social security number or tax identification number. Your signature and those of
two witnesses must also be provided. Your signature confirms the interest identifed below to Owner#30105466,and binds
you to the terms on the reverse side of this division order document effective as of 7:00 A.M.as shown below. Please return
one copy of the executed division order to Diamond Shamrock Refining and Marketing Company,Attention:Division
Order Section,525 Central Park Drive,Suite 425 Oklahoma City,Oklahoma 73105-1702,(405)525-8100 or(800)851-1901.
Please refer to the Instructions for Execution on the reverse side of this document.
To ensure complete information for state and federal tax reporting,please circle the appropriate response to the follo g:
Are you a foreign citizen or foreign corporation? Yes/Ni Are u a US Citizen residing in a foreign country? Ye
Are you lncorp ated? Ye. o Are you a tax-exempt entity'. Ye To(if yes,please provide documentation)
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OwC er(S)Signature e { i
M. J. 1e, air
84-6000-813
Social Security or Tax ID# Signature of Wi 1 q
Cl-rk o the B.and �i0;:
915 10th Street.
Address Signature of Witn
Deputy Clerk to the Boa
Greeley, Colorado 80631 970 356-4000 X4200 �
City,State and Zip Code Voice/FAX Telephone Number
Effective
Owner Name Interest Type Decimal Interest Date SR
WELD COUNTY BOARD OF COMMISSIO Royalty Interest 0.000078100 02-01-2001
2001-0987
YOUR COPY
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 appli e.
- �f
'BY: /VI
Coy Attorney
DATE: �//7•G'
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