HomeMy WebLinkAbout20001989.tiff NADOA Model Form Division Order(Adopted 9)95)
DIVISION ORDER
To: Prima Oil & Gas Company Date: August 4, 2000
1801 Broadway, Suite 500 YOUR COPY Effective Date: April 1, 2000
Denver, CO 80202
Property Number: 348002
Property Name: Neumann #1
Operator: Prima Oil & Gas Company
County and State: Weld County, Colorado
Property Description: T6N, R67W, 6th P.M., Section 24: NW/4NE/4
Production: X Oil X Gas Other _
Owner Name and Address: OWNER NUMBER:
SEE EXHIBIT "A"ATTACHED HERETO
Type of Interest:
Decimal Interest:
The undersigned certifies the ownership of their decimal interest in production or proceeds as described
on Exhibit"A" payable by Prima Oil & Gas Company (Payor).
Payor 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.
Payor is authorized to withhold payment pending resolution of a title dispute or adverse claim regarding
the interest in production claimed herein by the undersigned. The undersigned agrees to indemnify and
reimburse Payor any amount attributable to an interest to which the undersigned is not entitled.
Payor may accrue proceeds until the total amount equals $25.00, or pay once a year whichever occurs
first, or as required by applicable state statue.
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 Payor may have
certain statutory rights under the laws of the state in which the property is located.
Special Clauses:
Chair, Boa of Co ,nfi, or it s'ior,ers
if
Owner(s)Signature: r`.. .� - - • ;* _� '
_
Owner(s) Tax ID Number(s) r r : .�3fi�� � � LERI T0‘fiig%D� '
Owner Daytime Telephone#: (970) 3561 r �;rr 1 j Wit eSs ;; •
O. EPUTY CLE T :, THI. BOAS
Owner FM Telephone#. (970) 352 i' " _%, it s __--
A�
Federal Law requires you to furnish your Socia ~ r Taxpayer Identification Number.
Failure to comply will result in 31% tax withholding and will not be refundable by Payor.
200('- 1989
EXHIBIT "A"
Division of Interest for Neumann#1
Owner No. Name&Address Decimal Interest
Royalty Interest
107606 Wilma Irene Hettinger 0.04901;290
3500 Carlton Avenue 4045
Fort Collins,CO 80525--5717
107609 Sara Czapinski 0.038" 835
P. O. Box 3051
Avon.CO 81620
107610 Karen Brooks Rhea 0.038'x_'835
210 Starlite Drive
Pueblo.CO 81005-2670
107607 W. Lee Detterer 0.0350:920
31815 Weld County Road 23 -3/4
Greeley,CO 80631
107608 Darryl Grauberger&Brenda Grauberger 0.0017'110
610 Elm Street
Windsor,CO 80550
102187 Weld County Board of Commissioners 0.0011+150
915 10th Street
Greeley,CO 80631
Overriding Royalty Interest
107609 Sara Czapinski 0.01668930
P. O. Box 3051
Avon,CO 81620
107610 Karen Brooks Rhea 0.01668930
210 Starlite Drive
Pueblo,CO 81005-2670
Working Interest
000001 Prima Oil &Gas Company 0.80000000
Total 1.00000000
Page 1 of 1
MINIMS 4TISIINIIINIfnMOSy
PRIMA
OIL & GAS COMPANY
!fi ;I liro2dwaiy Surie '5Oli
02 i ver, Colorado 00202
lr 1 3i)]-29/-230(; _
Fa ;iw 297-7/08 -
rvc.>V.,mimwiTFr9yl wn
August 4, 2000
Dear Interest Owner:
Prima Oil & Gas Company has taken over operation of the Neumann #1 well in the
NW/4NE/4 of Section 24, Township 6 North, Range 67 West, Weld County, Colorado, effective
April 1, 2000. Enclosed are Division Orders covering your interest in this well. We ask that you
sign the Division Orders according to the enclosed instructions and return a signed copy to our
office. If we have your signed Division Order by August 18,we will be able to release your revenues
for payment with the August disbursement.
Should you have any questions or concerns regarding your interest in the Neumann 41 well,
please feel free to contact our office.
Very truly yours
Marlene Boyle
Division Order Analyst
MB:mh
3
INSTRUCTIONS TO INTEREST OWNERS
This instrument should not be altered in any way unless accompanied by documentary evidence suppo,ling the
change.
]f nai rn and interest are correctly shown:
I. Interest owner should sign as shown on the instrument since it reflects record title. If name has hanged.
please alter the Division Order when executing it and attach a copy of the marriage cerlif Ica te, divorce
decree, change of name certificate or other supporting document.
2. All individual signatures should be witnessed by two disinterested and unrelated parties.
3. For joint interest or life estate interests, execution should include signatures of all joi w ov ners rn
remaindermen, as appropriate.
4. If signed by agent, attorney-in-fact,or any party other than the named interest owner, evidence of tie rights
vested in the signatory party must be furnished (if not already furnished).
5. All partners must sign for a partnership unless signature is that of an authorized partner, cord lied r.opy o
his authority must be furnished (if not already furnished).
6. If.signature is that of an officer of a corporation, signature must be attested, title of signatory party ;howl'
and corporate seal affixed.
7. Verify address to which checks are to be mailed and make corrections if necessary. (If subsequent hange
of address is necessary, please notify us promptly, including your Owner Number, which appears on your
check).
8. Tax Identification Number or Social Security Number must be inserted in the space provided. fire Interna
Revenue Service requires that we withhold 31%of the proceeds payable to any owner who does not I urnish
such number. If qualified under Federal Regulation as TAX EXEMPT, copy of Certilicm ion if "Fa\
Exemption should be furnished.
RETURN ONE FULLY EXECUTED INSTRUMENT PROMPTLY TO THE ADDRESS BE!.O n:
KEEP THE OTHER COPY FOR YOUR RECORDS.
Prima Oil & Gas Company
1801 Broadway, Suite 500
Denver, CO 80202
Attention: Marlene Boyle
(303) 297-2300
Checks will be issued by our accounting department monthly upon receipt of the fully executed Division t'rden
They are normally mailed out around the 20th of each month. However,funds will be held until they iota. .'25.00
and/or on an annual basis.
COUNTY ATTORNEY STAFF APPROVAL
This is to affirm the attached Division Order and Authorization to
Receive Payment for an Oil and Gas WWli-Ipas been reviewed by
the County Attorney's staff as to forrn,(lege(I description, and
percentage of royalties, if applicable.
BY:
County ofney
DATE: � � -'
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