HomeMy WebLinkAbout911372.tiff AR22?0080 B 1318 R- 02270080 11/22/91 10 :59 $0. 00 1/006
F 0193 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO
RESOLUTION
RE: APPROVE DIVISION ORDER WITH NATIONAL COOPERATIVE REFINERY ASSOCIATION AND
AUTHORIZE CHAIRMAN TO SIGN
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
WHEREAS, Weld County, Colorado, has received a Division Order with National
Cooperative Refinery Association, P.O. Box 1404, McPherson, KS 67460-1404, and
WHEREAS, said Division Order covers land more particularly described as
follows:
Township 8 North, Range 58 West, 6th P.M.
Section 28: SE e NE;
Weld County, Colorado
WHEREAS, Weld County is entitled to a one-eighth royalty interest on
production, and
WHEREAS, in order to receive said royalty interest, Weld County must
execute said Division Order, a copy of which is attached hereto and incorporated
herein by reference, and
WHEREAS, said Division Order has been reviewed by a member of the Weld
County Attorney's staff and found to be in order, and
WHEREAS, the Board deems it advisable to approve said Division Order on the
parcel of land described herein.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Division Order with National Cooperative Refinery
Association, P.O. Box 1404, McPherson, KS 67460-1404, on the hereinabove
described parcel of land be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said Division Order.
911372
LNEDOID
GG, Aft' (,Rttc° eTW)
. _ �.
B 1318 REC 02270080 11/22/91 10 : 59 $0 . 00 2/006
F 0194 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO
Page 2
RE: DIVISION ORDER - NATIONAL COOPERATIVE REFINERY ASSOC.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the followin vote on the 18th day of November, A.D. , 1991.
ATTESTa4.47
BOARD OF COUNTY COMMISSIONERS
WELD COUNT ORADO
Weld County Clgjk to,the Board
R"y f Gordo acy, C rman
By: / . h a� EXCUSED
Deputy 'C,j ' �hh Boar Geo ge Kennedy, Pro-Tem
: , /
APPROVED AS , q'f*-L ,7" .A.t.al- a,
Constance L. Harbert
_ `
- ete0 erne-,
County Attorney C. W. Kir y
bifk 1,6,6u, on
W. H. Webster
911372
DIVISION ORDER
NATIONAL COOPERATIVE REFINERY ASS0CIATIIZOLD
CCl i "HP2,
Analyst: rlk 7
ti\ Pr1 fQl-1 1
T0: NCRA \ C I `f DATE: Octob ����3�1� , 1991
P.O. Box 1404 �R\ LEASE NAMEci9Tf'ONER UNIT TR. 11
McPherson, KS 67460-1404 '•a �q LEASE NIQ Ui4C3l-:• "i;
Attention: Division Order
Department
The undersigned, and each of them, guarantee and warrant that they are the legal owners in the proportions set
out below of all the oil and gas produced from the following described premises and until further written notice
you are authorized to receive oil and gas therefrom, giving credit as directed below, effective as of 7:00 a.m. ,
Effective Date: See Attached Exhibit "A°
Township 8 North, Range 58 West, 6th P.M.
Section 28: SE/4 NE/4
Weld County, Colorado
Credit to Division and Kind of Interest
FOR DIVISION OF INTEREST SEE
EXHIBIT "A" ATTACHED HERETO AND
MADE A PART OF THIS DIVISION ORDER
The following covenants are a part of this division order and shall be binding on the undersigned, their
successors, legal representatives, and assigns:
FIRST: Saida'shall become your property upon the delivery thereof to you or teeny carrier,pipeline.person,firm or corporation designated by you to receive said al.
SECOND. The oil purchased and received hereunder shall be delivered f.o.b.to anycarrleq pipeline,tanks or other facilities designated by you which gathers and receives sold oil,and you agree to
pay for such al to the respecUve owners according to thedivlelen of interest herein epecilied at the price posted by NCRA for oil of the same grade,gravity and quality from the field or area in which the
aloredescribsd lease or penises is located on the date said al is received by you,lees any lax you may be required to payard less applicable trucking or pipeline gathering charges in accordance with
arrangements made with the operator.
TIMID Quantities of al purchased hereunder shall be computed in accordance with the conditions specified in the price posting°MeekYou have the unqualified right to refuse to receive any oil not
considered merchantable by you or of acceptable quality.
FOUTOI:The proceeds of such al,after deducting any Wieser other charges as are herein provided and except as is provided in paragraph SIXTH,shall be paid monthly for al received and purchased
durbg the preceding month according to the division of intereclsel out herein,by check or draft mailed to each party al their address herein designated,except it the amount payable loany perry shall be
less than$25.00 payment shall be made sampan uat fy.
FFlX: Operators and/or working interest owners,sed each of them by execution of this division order,hereby certify and warrant Metall al sold hereunder has been and will be produced and handled
incompliance with the Falr Labor Standards Am of 1939,any amendments thereto,the regulations promulgated thereunder,and all other applicable federal,stale and municipal laws,rubs and reg-
ulations.
SIXTH: Abstracters other evdence°,title,satisfactory toyou,will be furnished upon demand.II,in your opinion the undersigned does net have good and merchantable litle,or in case of adverse claim
of title to the land and/or oil produced therefrom,you&reauthorized towithhold,without interest and without liability,the purchase price or proceeds of said al,until indemnify satisfactory to you has
been furnished or until suchtitleismadeacceptableto you or until such adverse claim is settled to your eatisfaclion II suit is tiled affecting the interest of any of the undersigned,written notice thereof
shall be given you at the above address by the partyor parties affected,together with&certified copy of the complaint or petition.The path or parties affected thereby agree to indemnify you against any
judgement rendered therein and to reimburse you for any cost,attorneys'lees or other expenses incurred in connection therewith.
SEVENIH: You will not be responsible forany change of ownership in the absence of actual notice and proof thereof satisfactoryto you and receipt by you of a proper and executed transfer order
signed by transferor and transferee together with a certified copy of the recorded instrument evidencing such Iranater.Any change or transfer of interest shall be effective at 7.00 o'clock a.m.On the
first day of the calendar month following the receipt of said notice.Without regard to whether any contingency or condition is exprecsfyslated in this division order,you are hereby relieved clans respon-
sibility for determining when any of the interest hereinshall increase,diminish,change,be extinguished or revert toother parties as result of the completion or discharge of money,production or other
payments from said interest or lor any other reasonard until you receive the aforesaid notice,satisfactory proof and transfer orders to the contrary,you are hereby authorized to remit pursuant to the
above division of interest.In the event the aforesaid written notice,satisfactory proof and transfer orders are not received by you,you shall be held harmless Mr error resulting in over or under payment,
rs a wrong payment of any sums.
IMPORTANT - To Avoid Delay In Payment - Your Correct Address and Social
Security Number orjTa Account Nu er Must Be Shown.
Y
° 1
Witness: ALtdA. �� � Owner's signature:
18ted, cvfClerk to Board BOARD OF COUNTY COMMISSIONERS OF
1/44 WELD zr,Rnde
ADO
gy., � ,Cx BY:
Deputy Clerk to Bc3at -\ 11/18/91
TITLE: Chair
Owner's Address:
P.O. Box 758
915 10th Street
Greeley, CO 80632
Owner's Social Security or Tax Account No. 84-6000813
If an individual your signature must be witnessed. If a partnership all partners must sign. If a corporation
execution and attestation must be by authorized officer, indicating the officer's corporate title.
S 1318 REC 02270080 11/22/91 10 :59 $0 . 00 3/006
F 0195 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO
01 `P'707.1
October 31, 1991
SOONER UNIT TR. 11 - #84322
SE/4 NE/4 SEC. 28-8N-58W
WELD COUNTY, COLORADO
EXHIBIT "A"
1/4O o PAGE ONE OF THREE
o V
0
a o ROYALTY INTEREST DECIMAL OF INTEREST
V
q Effective Date: ( 10/88 )
a
O 3 Board of County Commissioners of . 1250000 RI
o a Weld County, Colorado
� w
c4 OVERRIDING ROYALTY INTEREST
V
o, x Effective Date: 10/88 through 12/89
o John M. Turner . 0005000 ORI
a
a Jack H. Farrior . 0005000 ORI
0, O
N z Albert M. Pardini . 0006000 ORI
N H
, h Colburn R. Thomason . 0009000 ORI
a
O1;1 Kelly Thomason . 0012500 ORI
co w
04,
Michael Lance Thomason . 0012500 ORI
r z
N 44 Oscar Strongin . 0018750 ORI
0
w
x * Diversified Operating Corporation . 0027915 ORI BPO
x x
co .D
rn —I OVERRIDING ROYALTY INTEREST
-i o
a) 54 Effective Date: 01/90
BEFORE PAYOUT AFTER PAYOUT
John M. Turner . 0005000 ORI . 0005000 ORI
Jack H. Farrior . 0005000 ORI . 0005000 ORI
Albert M. Pardini . 0006000 ORI . 0006000 ORI
Colburn R. Thomasoh . 0009000 ORI . 0009000 ORI
Kelly Thomason . 0012500 ORI . 0012500 ORI
Michael Lance Thomason . 0012500 ORI . 0012500 ORI
Oscar Strongin . 0018750 ORI . 0018750 ORI
* Terry J. Cammon . 0013958 ORI . 0018645 ORI
* John Penn Lee . 0013957 ORI . 0018645 ORI
TOTAL OVERRIDING ROYALTY INTEREST .0096665 ORI .0106040 ORI
WORKING INTEREST
Effective 10/88 through 3/91
BEFORE PAYOUT AFTER PAYOUT
* Diversified Operating Corporation . 0870887 WI . 0869900 WI
* Grassy Hill Management Inc. . 0058448 WI . 0058448 WI
S._/.
October 31, 1991
SOONER UNIT TR. 11 - 184322
SE/4 NE/4 SEC. 28-8N-58W
WELD COUNTY, COLORADO
EXHIBIT "A"
0 u PAGE TWO OF THREE
0
n o WORKING INTEREST (cont. ) DECIMAL OF INTEREST
v
a Effective 10/88 through 3/91
ow DEFORE PAYOUT AFTER PAYOUT
� 3
w * E.D. Warde & Sons . 0541626 WI . 0540968 WI
Q
o R.S.J. , Inc. . 0818262 WI . 0818262 WI
V
zl
0\ x * Mile Hi Oil & Gas Inc. . 5389186 WI . 6356382 WI
2 x Jacqueline Kennedy . 0162487 WI No Interest
x
a Frank L. Musgrave . 0270813 WI No Interest
0, c.)
N z Robert Schoeneshoefer . 0541626 WI No Interest
N H
rfl TOTAL WORKING INTEREST .8653335 WI .8643960 WI
a
w-
0 p
0 w WORKING INTEREST
0
r- z
Nz Effective 04/91 through 05/91
0 BEFORE PAYOUT AFTER PAYOUT
r
a * Diversified Operating Corporation . 1006294 WI . 0869900 WI
co
* Grassy Hill Management Inc. . 0193854 WI . 0058448 WI
r, CD
1 0 * E.D. Warde & Sons . 0541626 WI . 0540968 WI
w aa
R. S .J. , Inc. . 0818262 WI . 0818262 WI
* Mile Hi Oil & Gas Inc. . 5389186 WI .6356382 WI
Jacqueline Kennedy . 0162487 WI No Interest
Frank L. Musgrave No Interest No Interest
Robert Schoeneshoefer . 0541626 WI No Interest
TOTAL WORKING INTEREST .8653335 WI .8643960 WI
W( M,Ig6 INTEREST
Effective 05/91 through 06/91
BEFORE PAYOUT AFTER PAYOUT
* Diversified Operating Corporation . 1277107 WI .0869900 WI
* Grassy Hill Management Inc. . 0464667 WI .0058448 WI
* E.D. Warde & Sons . 0541626 WI . 0540968 WI
R.S.J. , Inc. . 0818262 WI . 0818262 WI
* Mile Hi Oil & Gas Inc. . 5389186 WI . 6356382 WI
Jacqueline Kennedy .0162487 WI No Interest
October 31, 1991
SOONER UNIT TR. 11 - #84322
SE/4 NE/4 SEC. 28-8N-58W
WELD COUNTY, COLORADO
Lo o
o EXHIBIT "A"
ov PAGE THREE OF THREE
ca
0 al
WORKING INTEREST (cont. ) DECIMAL OF INTEREST
og
o x Effective 05/91 through 06/91
"9- a BEFORE PAYOUT AFTER PAYOUT
ca
x
o Frank L. Musgrave No Interest No Interest
w
� x
Robert Schoeneshoefer No Interest No Interest
..
0
ri a TOTAL WORKING INTEREST .8653335 WI .8643960 WI
w
� a
m U
N z WORKING INTEREST
N H
N H Effective 06/91
z BEFORE PAYOUT AFTER PAYOUT
w
o p
c° 41 * Diversified Operating Corporation . 1277107 WI . 0869900 WI
0
N z * Grassy Hill Management Inc. . 0464667 WI . 0058448 WI
N 4
r * E.D. Warde & Sons . 0541626 WI . 0540968 WI
C.) C4
W
x R.S.J. , Inc. . 0818262 WI . 0818262 WI
m w
M ti * Mile Hi oil & Gas Inc. .5551673 WI .6356382 WI
ri o
w w Jacqueline Kennedy No Interest No Interest
Frank L. Musgrave No Interest No Interest
Robert Schoeneshoefer No Interest No Interest
TOTAL WORKING INTEREST .8653335 WI .8643960 WI
* The above interest owners agree to notify National
Cooperative Refinery Association when After Payout has been
established, and that said owners save National Cooperative
Refinery Association harmless from any loss, cost or damages it
might suffer should such notice not be given.
Form 6458 OMB No. 15450230
(Rev June 1985) Certification and Election Form Expires 4.30-88
1545-
Department of the Treasury ► See separate Instructions.
Internal Revenue Serve
Name Taxpayer Identifying number
Weld County, Colorado, Board of County Commissioners 84-6000813
Address inumber and street)
915 10th Street, P.O. Box 758
City or town.state and ZIP code
Greeley, CO 80632
Name of purchaser(only completed by a purchaser who is forwarding a qualified disburser election) Taxpayer kleetlfying number
Part I 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):
® Qualified governmental interest(section 4994(a)) ❑ Exempt Indian oil(section 4994(d))
❑ Qualified charitable interest(section 4994(b)) ❑ Qualified independent producer of exempt stripper well oil(section
4994(g))
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 perjury, I declare that I have examined this certificate, including accompanying instructions,and to the best of my knowledge and
belief,It is true,correct,and complete.
CHAIRMAN, BOARD OF COMMI
Signature of exempt producer ► Date ► .///�.12/9
Part II Independent Producer Certificate
I certify that I qualify as an independent produ Certificate
defined in section 4992,and that all my taxable production from the properties
listed on the attached sheet is entitled to the lower rate of windfall profit tax for tier one and tier two oil.
The total taxable production from these properties (plus production from other qualified properties that I have certified) does not
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(eX2)). I am 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."
❑ I am not a member of a related group(as defined in section 4992(eX2D.
I understand that I must file Part III within 10 days after I no longer qualify as an independent producer.
Under penalties of perjury. I declare that I have examined this certificate, including accompanying instructions,and to the best of my knowledge and
belief,a is true,correct.and complete.
Signature of independent producer ► Date ►
Part III Revocation of a Previously Filed Certificate
I no longer qualify for exemption from,or reduced rates of,the windfall profit tax.The status that I previously claimed was:
❑ Qualified governmental interest ❑ Independent producer ❑ Qualified independent producer of exempt stripper well oil
❑ Qualified charitable interest ❑ Exempt Indian oil
Date of original certification ► Service Center where filed ►
Effective date of revocation ►
•
Signature of producer ► Date ►
Part IV Qualified Disburser Election
I certify that I am a qualified disburser as defined in regulations section 51.4995.5(b)and that 1 hereby elect to perform all the duties normally imposed
upon the purchaser in regard to the administration of the windfall profit tax.
I understand that I must file Part VI within 10 days after this election is terminated.
Effective date of election
Property(include full lease name,location,and identifying number,it apoicable)
Signature of qualified disburser Dater {
l.ASft Ms. 5.251
Form W-9 Request for Taxpayer Give this form
Department
the
Identification Number and Certification to the NOT end to IRS.Department of the Treasury
Internal Revenue Service
L Name (If joint names,list first and circle the name of the person or entity whose number you enter in Part I below.See Instructions under"Name"if your name has changed.)
a.
a Board of County Commissioners, Weld County, Colorado
13 Address(number and street) List account numoer(s)
a▪. P.O. Box 758 (915 10th Street) here(optionaq
" City,state.and ZIP code
'u
a Greeley, Colorado 80632
if it Taxpayer Identification Number(TIN) In For Payees Exempt From
Backup Withholding(See
Enter your taxpayer identification number in Instructions)
the appropriate box. For individuals and sole Social security number
proprietors, this is your social security number.
For other entities, it is your employer "I" + EXEMPT -- See Attached Form 6458
identification number. If you do not have a OR
number,see How To Obtain a TIN, below. Requester's name and address(optional)
Note:If the account is in more than one name, Employer Identification number
see the chart on page 2 for guidelines on whose 8 4 1-6 0 0 0 8 1 3
number to enter.
Certification.—Under penalties of perjury, I certify that:
(1) The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and
(2) I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the
Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)
the IRS has notified me that I am no longer subject to backup withholding.
Certification Instructions.—You must cross out item(2)above if you have been notified by IRS that you are currently subject to backup
withholding because of underreporting interest or dividends on your tax return.For real estate transactions,item(2)does not apply.For
mortgage interest paid,the acquisition or abandonment of secured pro rty,contributions to an individual retirement arrangement(IRA),
and generally payments other than interest and dividends,you are n equired to sign the Certification,but you must provide your correct
TIN.(Also see Signing the Certificatiop under Specific Instructio /6 page 2.)
Please
•
Sign % /7----/V----5/
/�/�7/
Here Signature to. ; ///� ►Date
Instructions requester.For reportable interest or dividend (2)IRS notifies the requester that you
payments,the payer must exercise one of the furnished an incorrect TIN,or
(Section references are to the Internal Revenue following options concerning backup withholding (3)You are notified by IRS that you are
Code.) during this 60-day period.Under option(1),a subject to backup withholding because you failed
Purpose of Form.—A person who is required to Payer must backup withhold on any withdrawals to report all your interest and dividends on your
file an information return with IRS must obtain you make from your account after 7 business tax return(for reportable interest and dividends
your correct taxpayer identification number(TIN) days after the requester receives this form back only),or
to report income paid to you,real estate from you.Under option(2),the payer must (q)You fail to certify to the requester that you
transactions,mortgage interest you paid,the backup withhold on any reportable interest or are not subject to backup withholding under(3)
acquisition or abandonment of secured property, dividend payments made to your account, above(for reportable interest and dividend ac-
counts• contributions you made to an individual regardless of whether you make any withdrawals. counts opened after 1983 only or
retirement arrangement(IRA).Use Form W-9 to The backup withholding under option(2)must
furnish your correct TIN to the requester(the begin no later than 7 business days after the (5)You fail to certify your TIN.This applies
person asking you to furnish your TIN),and,when requester receives this form back.Under option only to reportable interest,dividend,broker,or
applicable,(1)to certify that the TIN you are (2),the payer is required to refund the amounts barter exchange accounts opened after 1983,or
furnishing is correct(or that you are waiting for a withheld if your certified TIN is received within broker accounts considered inactive in 1983.
number to be issued),(2)to certify that you are the 60-day period and you were not subject to Except as explained in(5)above,other
not subject to backup withholding,and(3)to backup withholding during that period. reportable payments are subject to backup
claim exemption from backup withholding if you Note:Writing"Applied For"on the form means withholding only if(1)or(2)above applies.
are an exempt payee.Furnishing your correct TIN that you have already applied for a TIN OR that Certain payees and payments are exempt
and making the appropriate certifications will you intend to apply for one in the near future. from backup withholding and information
prevent certain payments from being subject to As soon as you receive your TIN,complete reporting.See Payees and Payments Exempt
the 20%backup withholding. another Form W-9,include your TIN,sign and From Backup Withholding,below,and Exempt
Note:If a requester gives you a form other than date the form,and give it to the requester. Payees and Payments under Specific
a W-9 to request your TIN,you must use the What Is Backup Withholdine—Persons making Instructions,on page 2,if you are an exempt
requester's form. certain payments to you are required to withhold payee.
How To Obtain a TIN.—If you do not have a TIN, and pay to IRS 20%of such payments under Payees and Payments Exempt From Backup
apply for one immediately.To apply,get Form certain conditions.This is called"backup Withholding.—The following is a list of payees
SS-5.Application for a Social Security Number withholding."Payments that could be subject to exempt from backup withholding and for which
Card(for individuals),from your local office of backup withholding include interest,dividends, no information reporting is required.For interest
the Social Security Administration,or Form SS-4, broker and barter exchange transactions,rents, and dividends,all listed payees are exempt
Application for Employer Identification Number royalties,nonemployee compensation,and except item(9).For broker transactions,payees
(for businesses and all other entities),from your certain payments from fishing boat operators,but listed in(1)through(13)and a person registered
local Internal Revenue Service office. do not include real estate transactions. under the Investment Advisers AM of 1940 who
To complete Form W-9 if you do not have a If you give the requester your correct TIN, regularly acts as a broker are exempt.Payments
TIN,write"Applied For"in the space for the TIN make the appropriate certifications,and report all subject to reporting under sections 6041 and
in Part I,sign and date the form,and give it to the your taxable interest and dividends on your tax 6041A are generally exempt from backup
requester.Generally,you will then have 60 days return,your payments will not be subject to withholding only if made to payees described in
to obtain a TIN and furnish it to the requester.If backup withholding.Payments you receive will be items(1)through(7),except that a corporation
the requester does not receive your TIN within 60 subject to backup withholding if: that provides medical and health care services or
days,backup withholding,if applicable,will begin (1)You do not furnish your TIN to the bills and collects payments for such services is
and continue until you furnish your TIN to the requester,or ! "7 Fr,
n" . .. .� rm
INSTRUCTIONS TO ALL INTER-3 OWNERS
Read Carefully before signing your Division/Transfer Order
THIS INSTRUMENT SHOULD NOT BE ALTERED IN ANY WAY UNLESS
ACCOMPANIED BY DOCUMENTARY EVIDENCE JUSTIFYING THE CHANGE. ANY
CORRECTIONS IN SPELLING OF YOUR NAME SHOULD BE MADE IN INK AND
YOUR INITIALS SHOWN ABOVE THE CORRECTION.
SIGNATURE: Sign your name as shown on the Division/Transfer
Order, in the space provided. Have your signature witnessed.
SIGNING FOR A CORPORATION, title of signatory party
must be shown, corporate seal affixed, and attested.
SIGNING FOR A PARTNERSHIP, all partners must sign
unless signed by an authorized party and we are
furnished a certified copy of his/her authority. If an
interest is shown jointly, each party must sign the
instrument in the manner that their name is shown. In
the event one party has been designated agent for the
joint interest, or if they have been granted a power of
attorney for the other party ( ies ) , we must have
evidence to support this .
SIGNATURE BY SECOND PARTY: If the Division/Transfer
Order is signed by agent, attorneys-in-fact, guardian,
trustee or any party other than the designated interest
owner, we must have evidence of the rights vested in
the signatory party.
NAILING ADDRESS: Indicate the address to which checks are to be
mailed . Print or type as clearly as possible . Do not
abbreviate . If you are already receiving checks from our
company, be sure to use the same address to which we are now
mailing your checks . Make sure to include your zip code number.
TAXPAYER' S IDENTIFICATION OR SOCIAL SECURITY NUMBER: As
required by the Interest and Dividend Compliance Act of 1983
( IDTCA, IRC 3406 ) , we are required to withhold twenty per cent
(20%) of all payments unless we are furnished with a federal
id/Social Security Number. Please be sure to indicate the
applicable number in the space provided.
LEASE NUMBER : In the upper right hand corner of the
Division/Transfer Order is a five-digit number. This number will
appear on the checkstub and should always be used when
corresponding with our company.
CHANGE OF ADDRESS: It is very important that you notify us
immediately of any change in your mailing address . Be sure to
include your owner number, which appears on your check from our
company, your old address , then state your new address . This
should be accompanied by your initials and/or signature.
RETURN THE EXECUTED DOCUMENT WITHOUT DELAY TO THE ADDRESS BELOW.
KEEP ONE COPY FOR YOUR RECORDS.
NATIONAL COOPERATIVE REFINERY ASSOCIATION
ATTENTION: DIVISION ORDER DEPARTMENT
NCRA BLDG. 2000 SOUTH MAIN, P.O. BOX 1404 01 -+^^*yrl
MCPHERSON, KANSAS 67460-1404
•
ti ' ° pp> National Cooperative ReTiehissociation
2000 SOUTH MAIN ST. • P.O. BOX 1404 • McPHERSON, KANSAS 67460 • 316/241-2340
Erni _� tit p. tin
q ti ,•
CLEER
TO TiF Ent' 1
November 4 , 1991
Board of County Commissioners
Weld County
Weld Cty. Centennial Center
P.O. Box 758
Greeley, CO 80632-0758
RE: SOONER UNIT TR. 11 - #84322
WELD COUNTY, COLORADO
Dear Interest Owner:
Effective October , 1988 , National Cooperative Refinery
Association (NCRA) began purchasing the crude oil production from
the referenced property.
The Division Orders should be signed by you, as the interest
owner , before witness , making sure to include your mailing
address and federal id number; without that information, we are
required, by the IRS, to withhold twenty per cent (208) from all
payments. A W-9 is enclosed, as a reminder in providing the tax
number.
One copy of the Division Order, is to be mailed to my attention
in the enclosed envelope, along with the completed W-9 Form. The
remaining copy is for your files .
If you have any questions, please contact me.
Sincerely,
NATIONAL COOPERATIVE
REFINERY ASSOCIATION
1 R(itfitaC-Ckki±
Rhonda L. Klatt
Division Order Analyst
Enclosures
RLK:dm
Supplying Refined Fuels FARMERS UNION CENTRAL EXCHANGE, INC., (GENE%), SAINT PAUL, MINNESOTA•FARMLAND INDUSTRIES, INC., KANSAS CITY, MISSOURI
To Our Member-Owners GROWMARK,INC.,BLOOMINGTON,ILUNOIS• MFA OIL COMPANY,COLUMBIA MISSOURI
Hello