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Home My WebLink About920857.tiff JU 230382a RESOLUTION RE: APPROVE OIL AND GAS DIVISION ORDER TO AMOCO PRODUCTION COMPANY 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 w W o WHEREAS, Weld County, Colorado, has received an Oil and Gas Division Order co w to Amoco Production Company, P.O. Box 591, Tulsa, Oklahoma 74102, and of d7 K n WHEREAS, said Division Order covers land more particularly described as follows: w z w Township 2 North, Range 67 West, 6th P.M. Section 13: Si as to gas and associated liquid hydrocarbons woo from J Sand C v' Weld County, Colorado coo Hko tz: H H WHEREAS, Weld County is entitled to a one-eighth royalty interest on production, andn N th WHEREAS, in order to receive said royalty interest, Weld County must x N execute said Division Order, a copy of which is attached hereto and incorporated an w herein by reference, and W +' 0 0 WHEREAS, said Division Order has been reviewed by a member of the Weld O County Attorney's staff and found to be in order, and �yo � o too WHEREAS, the Board deems it advisable to approve said Division Order on the d parcel of land described herein. O NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld 0 0 County, Colorado, that the Oil and Gas Division Order to Amoco Production Company, P.O. Box 591, Tulsa, Oklahoma 74102, 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. 920857 �G . rtMOLOEPLtRPOr2TE-0) c1\ 90 DIVISION ORDER - AMOCO PRODUCTION COMPANY PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 14th day of September, A.D. , 1992. BOARD OF COUNTY COMMISSIONERS h W ATTEST: Pi 'i WELD COUNTY, COLORADO o r Lie4/cr�GLuCO w - Weld County Clerk to the Board G e Ke edy, Chairman ry �C A BY: o Deputy CiV the Board Constance L. Harbe , ro-Tem z W APPROVED AS T ORM: co it w C. W. y C u, County ttorney Gordon E. Lacy H 1021/404./O z -4 4 W. ebster n 1/40 o can 0. eII x r w C] O l7 Ulan a ao Uy o a 0 n N ` O A o o rn 920857 L Amoco Production Company T CBA 010 Oil and Gas Division Order P,tg�: 1 08-05-92 Effective At 7 A.M. 06-31-92 PLUS ALL SUMS ACCRUED Property Name EASTMAN, JAC< W. GAS UNIT LPN 638445--- Royalty/Product Operator AMOCO PRODUCTION COMPANY Property No. 400438 00 8 Field WATTENBERS (FLAG) 00 10 000 State C 0 County/Parish WELD Special Notes Description of Property T2 1-R67W. SEC:13 It AS TO GAS AND ASSOCIATEI, LIOUIO AIPR1CARBONS FR04 J SAND • L Ig .t Type Decimal-1 Business Associate Name Int. Interest Number 756416 00 4 ENERGY MINERALS CORPORATION 02 .0264375 120499 00 9 HEIT, ANTONE 04 .0025390 120495 00 7 HETT► GEORS 04 .0025390 215127 00 4 HETT, ;'3TTLIE5 J 04 .0025390 X04 I .0025390 120490 00 1 NETT, JON'S 4 1 120493 0:0 2 HEIT, LEnNA20 J 04 .0025390 7 4 04 .0025390 12O494 00 0 MORAN, MARY 4. 120679 00 6 MUXLEY, JOYCE M 04 ! .0025390 4 -- O4I .0025390 12''4'77 00 3 SACK, JULIA ___-- ' 765255 00 5 WELD COUNTY COLORADO 041 •0238986 Cl)' BOAR() OF COUNTY C7RMISS IONERS 1 571051 00 2 WF_THINSTON, ELIZABETH A 04 .0025390 123446 00 5 WUERT1, KATHERINE 04 .0025390 B 1351 REC 02303825 09/17/92 15 : 34 $0 .00 5/006 F 0900 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO Type Interest Legend: 01 =Working Interest 02 = Overriding Royalty 03 = Production Payment 04 =Royalty Interest Form 899 Jan-85 9Z0857 B 1351 REC 02303825 09/17/92 15 :34 $0 .00 6/006 F 0901 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO _I 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 more other tracts of land, this instrument shall thereafter be deemed to be modified to the extent necessary to conform with the applicable unitization agreement or plan of unitization,and all revisions or amendments thereto,but otherwise to remain in force and 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 to have been actually produced from said land. You agree to pay for the oil sold hereunder at the price posted by you for oil of the same grade and gravity in the same producing field or area on the date said oilis received by you or the designated carrier. If you do not currently post such a price, then until 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, tankcar, or pipe line transportation charge 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 title,you agree to pay for such oil based upon the volume computation made by such purchaser and at the price received by you for such oil, reduced by any transportation charges deducted by such purchaser. Quality and quantity shall be determined in accordance with the conditions specified in the price posting.You may refuse to receive any oil not considered merchantable by you. Gas: Settlements for gas shall be based on the net proceeds realized from the sale thereof,after deduction 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 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. Settlements: Settlements shall be made monthly by check mailed to the respective parties according to the division of interest herein 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 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 thereof, you will be furnished satisfactory abstracts or other evidence of title upon demand. Until such evidence of title has been furnished and/or such dispute,defect,or question of title is corrected or removed to your satisfaction,or until indemnity satisfactory to you has been furnished,you are authorized to withhold the proceeds of such oil or gas received and run,without interest. In the 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 filling of such suit or action shall be immediately furnished you by the undersigned,stating the court in which the same is filed and the title of such suitor action. You will not be responsible for any change of ownership in the absence of actual notice and satisfactory proof thereof. Contingent Interests:Whether or not any contingency is expressly stated in this instrument,you are hereby relieved of any responsibility for determining when any of the interests herein shall increase,diminish,terminate,be extinguished or revert to other parties as a result 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 limitation (either definite or indefinite(,and,unless you are also the operator of the property,as a result of an increase or decrease in 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 of production affecting the herein described land or any portion thereof under any agreement or by order of Governmental authority, and until you 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, 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- under has been and shall be produced from or lawfully allocated to the herein described land in accordance with all applicable Federal, 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. //�J' //�� WELD COUNTY COMMISSIONERS ATTEST: /�/1114tt7 Witness of Signature Geo e Kennedy, Chair Street or Box No. Weld County Clerk to the /Board 84-6000-813 i,/ / Social Security for Tax ID)Number City,State,Zip BY: i Z'J - i : <�- - rd ( Deputy Clerk to the Board_ Witness of Signature �Name Street or Boa No. Social Security(or Tax ID)Number City,State,Zip Witness of Signature Name Street or Box No. Social Security(or Tax ID)Number City,State,Zip 920Q V(� 857 N, • Amoco Production Company A ;Am oco. . C B A O1O Oil and Gas Division Order Page 1 O8-O5-92 Effective At 7 A.M. O6-O1-92 PLUS ALL SUMS ACCRUED Property Name EASTMAN, JAC< Wt GAS UNIT LPN b38445--- Royalty/Product Operator AMOCO PZ33UCTIJN COMPANY Property No. 4OO438 OO 8 State C O County/Parish w EL O rDescription of Property Special Notes T2N-r' 7r1t SEC.13 S/2 AS TO .;AS 44O ASS7CtATE9. :LIQ.UIO ltDROCARi0NS FROM J SAND i�4'w !is Type Decimal Business Associate Name Int. Interest Number 756416 OO 4 ENERGY MINERALS CORPORATION O2 .O264375 --{ 121499 OO 9 HEITt ATONE O4 .OO2539O 12O495 OO 7 HET I, GEORGE O4 .OO2539O 916127 OO 4 NETT• GOTTLIEB J 04 .OO2539O 12_O493 OO 1 HET ;* JOHN 04 .OO2539O 12O493 OO 2 HFIT, LEONARD '! 04 .OO2539O 12.0494 OO O MORGA4, MARY O4 .0025390 12OS79 OO 6 MOXLEY, JOYCE 4O4 .OO2539O 7 12O497 Ot) I SACK, JULIA O4 ' .OO2539O 765255 OO 5 WELD COUNTY COLORADO O4 .O238986 C/1 13DARO 3F COUNTY COMMISSIONERS 571O51 O1) 2 WETHINSTOMt ELIZA SETH A O4 .0025390 12.0496 OO 5 WUERTZ, KATHERINE O4 .OO2539O $0 . 00 3/OO6 B 1351 REC O23O3825 O9/ 17/92 15 :3 F 0898 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO Type Interest Legend: - 01 =Working Interest 02 =Overriding Royalty 03 = Production Payment 04dt►d14� 1t Form 899 Jan-85 j T ce4,+l� - - Y B 1351 REC 02303825 09/17/92 15 :34 $0 . 00 4/006 F 0899 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO � • • OH 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 ojl. 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 more other tracts of land, this instrument shall thereafter be deemed to be modified to the extent necessary to conform with the applicable unitization agreement or plan of unitization,and all revisions or amendments thereto,but otherwise to remain in force and 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 to have been actually produced from said land. You agree to pay for the oil sold hereunder at the price posted by you for oil of the same grade and gravity in the same producing field or area on the date said oilis received by you or the designated carrier. If you do not currently post such a price, then until 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, tankcar, or pipe line transportation charge as determined by you. Should the oil sold hereunder be resold by you to another accepting • title,you agree to pay for such oil based upon the volumeomputationmade d by such purchaser and at atthesthe ameprriice receiveatd by yy y take such oil, reduced by any transportation charges deducted by such purchaser. ointou for Quality and quantity shall be determined in accordance with the conditions specified in the price posting.You may refuse to receive any oil not considered merchantable by you. Gas: Settlements for gas shall be based on the net proceeds realized from the sale thereof,after deduction 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 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. Settlements: Settlements shall be made monthly by check mailed to the respective parties according to the division of interest herein 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 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 thereof, you will be furnished satisfactory abstracts or other evidence of title upon demand. Until such evidence of title has been furnished and/or such dispute,defect,or question of title is corrected or removed to your satisfaction,or until indemnity satisfactory to you has been furnished, you are authorized to withhold the proceeds of such oil or gas received and run,without interest. In the 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 filling of such suit or action shall be immediately furnished you by the undersigned,stating the court in which the same is filed and the title of such suitor action. You will not be responsible for any change of ownership in the absence of actual notice and satisfactory proof thereof. Contingent Interests:Whether or not any contingency is expressly stated in this instrument,you are hereby relieved of any responsibility for determining when any of the interests herein shall increase,diminish,terminate,be extinguished or revert to other parties as a result 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 limitation (either definite or indefinite),and,unless you are also the operator of the property,as a result of an increase or decrease in 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 of production affecting the herein described land or any portion thereof under any agreement or by order of Governmental authority, and until you 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, 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- under has been and shall be produced from or lawfully allocated to the herein described land in accordance with all applicable Federal, state and local laws, orders, rules and regulations. Th s instument mabe executed by one or more,but ovenants herein shall be bindin n any party executing his heirs,dev sees,ysucce successors, and assigns irrespectivlecof whether other parties have e9 e�ted this i strument, same and upon Weld County Commissioners ATTEST: 5J 1O'á4L'; ../ O. Box 758 `�eya°fC�Ounty Clerk/'to the Board° eorge nne y, Chairman Scree or Box No. // � , 1 84-6000-813 Greeley, CO 80632 BYe y / „.1-;- A). j Social Security for Tax ID) "�"�^ � Number City,State,Zip Deputy Clerk to the Board Witness of Signature ------.__i Name Street or Box No. Social Security for Tax ID)Number City,State,Zip Witness of Signature Name Street or Box No. Social Security for Tax ID)Number City,State,Zip • 920857 `T II-• Amoco Production Company Post Office Box 591 Tulsa,Oklahoma 74102-0591 August 6, 1992 To All Interest Owners Effective June 1992, Amoco acquired Basin Exploration's interest in the following properties located in Weld County, Colorado: Jack C. Noel Unit L-616830--- (400086-5) John Martinez Gas Unit L-618544--- (400120-2) Sidney Strear Gas Unit L-631269--- (400224-2) Phillip S McCoy Gas Unit/D/ L-631749--- (400246-5) Jack W Eastman Gas Unit L-638445--- (400438-8) Benjamin Trunzo Gas Unit L-614167--- (410443-6) Alvin Vonasek Gas Unit L-613382--- (410608-4) Richard W Means Gas Unit L-612333--- (410587-0) G Pickering Gas Unit L-613529--- (410356-0) Enclosed are Division Orders for the above properties. Please verify your interest on these instruments, insert your taxpayer identification number, check the spelling of your name, and indicate your correct remittance address. Please execute the Division Order before a witness, and return one copy to this office in the envelope provided along with the Payor's Request for Taxpayer Identification Number and Certificate form. The extra copy of the division order is for your records. If we can be of further assistance, please contact me at (918) 581- 4817. Lisa Muttoni Business Analyst Tulsa Accounting Center Enclosures 920857 • Instructions To All Interest Owners Read Carefully Before Signing The Instrument This instrument should not be altered in any way unless accompanied by documentary evidence to support the change. If your name and interest are correctly shown: Signature: Sign name as shown on the instrument. Have your signature witnessed. If signing for a corporation, signature must be attested, corporate seal affixed, and title of signatory party shown. Signature by Second If the instrument is signed by agent,attorney-in-fact, guardian or any party other than Party: the named interest owner,we must have evidence of the rights vested in the signatory party. Taxpayers Identification Effective January 1, 1984, the Internal Revenue Code requires a payer to withhold Number or Social from payments a tax equal to 20% of such payments where a correct taxpayer Security Number: identification number has not been furnished. Please insert your number in the space provided below your name on the instrument in accordance with the instructions reproduced on the reverse side hereof. Also to ensure accurate income information reporting of payments for your account, please complete the enclosed"Payer's Request For Taxpayer Identification Number" and return with your signed Division Order. Mailing Address: Insert the address to which checks are to be mailed. Print or type. Do not abbreviate. If you are already receiving checks from this company, be sure to use the same address to which we are now mailing checks. Property Number: In the upper right comer of the instrument you will find the number assigned to this property.The six digit number will be identified as the Property number or FLAG.This number will appear on the statement attached to your check and should always be used when corresponding with this company. Settlement for your Upon receipt of the properly executed instrument and evidence of clear title. the Interest: interest credited to you will be authorized for payment. Instruments must be received in our office by the 20th of the month for checks to be issued the following month. Checks will be mailed monthly when accruals to your interest equal$25.00 or more. In May and November of each year payment will be made for all accumulated sums of more than $1.00. Change of Address: You should notify us promptly of any change in your mailing address. This notice must be over your own signature, or the signature of your appointed agent.Always include your business associate number and your old address, then state your new address with zip code. Return the executed instrument without delay to the address below. Keep one copy•for your records. Amoco Production Company (Attention: Division Order Section) P.O. Box 591 Tulsa. Oklahoma 74102 Any questions about your payments or other matters involving your interest should be directed to the above address. Attention: Royalty/Interest Owner Relations — Phone (918) 581-4800. (See mane side for additional information) nw SWAMI 920857 Instructions for furnishing Taxpayer Identification Number or Social Security Number: If this account is 1^ the name of: - An individual, fu ,h the individual's own social security nu er. A widow 62 or over who received social security benefits before January 1 . 1963, and who has no number of her own may use the benefit number for tax purposes. All other persons must have their own number. Two or more persons (for example, "A and B as joint owners" or "A, B, and C as tenants in common"), only one number need be furnished. Ordinarily, the number of any one of the persons will be sufficient, except that if the choice is between husband and wife, furnish the social security number of the husband—or if between adult and minor, furnish the social security number of the adult. Underline the name of the person whose number is furnished. A designated guardian, custodian, committee, etc., and one or more wards, minors, incompetents, or other individuals, furnish the social security number of the ward. minor, incompetent, etc., and underline the name of the individual whose number is furnished (for example, "A as custodian for B under the Uniform Gifts to Minors Act," furnish B's social security number and underline B's name). A so-called trust, which is not a legal or valid trust, furnish the social security number of the person named as trustee and underline his name (for example, a savings account, not formalized by a trust instrument, in the name of "A in trust for B." furnish the social security number of A and underline A's name). A trust, estate, pension trust, corporation, partnership, broker, registered nominee, etc., fumish the employer identification number of the entity (for example. "A, trustee under the will of S for benefit of Y." furnish the employer identification number of the trust). If an employer identification number is needed, contact any Internal Revenue Service office. If you do not now have a Social Security Number: You may obtain the form upon which to make application for a number at your nearest Social Security or Internal Revenue Service Office. When you have obtained your number notify this company of the same without delay at the Address appearing on the face hereof. How to read your check attachment enrages N0.101AC Nal sow n TM number aligned to the Amoco Production Company ONteesnr e1 01 as Sea PwMsad or 0W how. unit. roc. TM Mt CO.W III.THs.00taaaa 11112 IFS'S me Ss Taw Ni..ben ewes woe weal .w: a seenn r ex numbers Menthe the pro' bNl WOWOutesu W eae M Ns Maaax.Oupwna tarty be Wawa • erne TM next two numbers • ___ S11�2l-a4•a'nar'a�' YOUR NAME • • 3431!1 II 1 we the nub Drooats numbers `bar�dr$y� • • to walla misrent Noss • Total Value Vow*West of ores to be reeorbeb from prosy 1461 ••n I r. QsUMnity U PS. 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I•SsIS • MI I•se OMI 1•NIto I.14 Crow Yr POO 1• y►aM • NNW ate1, us1• t•ea Ni u moat. Ohs sled we pr. H.Sold" V rs la lew -loom ' 04 Wdewladeaho le•laar} b•MOS0N MOS h•hosed tla Tr fade M Imo Na Printed a1 the bottom of me II.hound is err earn Si Ws II•Intl ho ri her Shwa It•Irlesta ISM SOO Mane n•Nan he rr earl War tape Ism form. Codes Infrequently used ere =mount deal. ruts and prow or*s such transactions occur. •T.MTa-5•twanwand other MOSS taw qid on •laaaw Aaaalsse Number - The number soma the at or 9s Sold ham the ooauM.Federal sb0na ISMS w auclualsely to stuns,awns WI S ncluded on Vo per abo deducted la nenrsWnl awn. end shouts S laud a a taws when moss are made. •Otantlty-Grin edema Horan in berms,tea.or MCF TM number Mown laoy a only an sta. (Thousand Cubic Feet)sod from me Case Gusty Ameba enu •s MCF wawa 0se and Carbon sat 1C321. Note For TaaN Value Aber Tea-Net sake of totaleras from the lags0 Cods 07,easy a shown a"Vans Oar A•uw0 YOOrtly MHO IN was are tad. 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To 0 g a s 2 2 8 © =• a• .c a -• a• c N LL O m S © > O O W O a �s Anioeu r luuuct)uii Uoinpialiy `Tai —Payer's Request for Taxpaye ._111,11 o Identification Number and Certification i /5"iL 550,15 400433008 oat0000 caA0I0 ny whale numberyou enter in Part i wow) b a 3 WELD CJUNTY COLUitAOJ Part II For Payees Exem i C/O HOARD OF COUNTY COMMISSIUNERS Backup Wlthholdng(See WLLt) �.,JNTY C3;;d F ttUUSC Instructions) P (1 t3UR 75 GRErLEY♦ €3y 80632-0758 Lis he. Part Ill Nonforeign Affidavit (see — instructions) Part I Taxpayer Identification Number—For All Accounts t 7 am not a foreign person I = am a foreign person Enter your taxpayer identification number in social security number Section 1445 requires wrthholrnng or tax from the appropriate box. For most individuals, this foreign persons dispositions of United States isreal property interests.II not a foreign person have a nusocimber, security to Obaumber. )f you do not check the"am nor box to avoid withholding or a number,see How Obtain a TIN. OR taxes under this provision. 9 Note://the account is an more than one name, see the chart on page 2 for guidelines on which Employer idenakatlan number number to give the payer. 84-6000-813 Certlflcatlon.—Under penalties of perjury,I certify that: (1) The number shown on this form is my correct Taxpayer Identification Number(or 1 am waiting for a nuttier to be issued to me),and (2) I am not sublect to backup withholding either because I have not been notified by the Internal Revenue Service(IRS)that 1 am subject to backup withholding as a result of a failure to report all interest or dividends,or 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 subject to backup withholding because of underreporting interest or dividends on your tax return. However,if after being notified by IRS that you were subject to backup withholding you received another notification from IRS that you are no longer subject to backup withholding,do not cross out item(2).(Also see Certification under Specific Instructions.) Please Sign Here Signature areDate a. 9/14/92 . Instructions (1)You do not furnish y of e payer,or If you do not have a TIN,write'Applied For (Section references are to the Internal Revenue (2)IRS notifies the payer that you furnished in the space for the TIN in Part I,sign and date Code.) an incorrect TIN,or the form.and give it to the payer.You will then (3)You are notified by IRS that you are have 60 days 10 obtain a TIN and furnish it to the Purpose of Form subject to backup withholding because you failed payer.During the 60•day period,the payments Complete this form and give it to the payer or to report all your interest and dividends on your you receive will not De subject to the 20%backup nterest.dividends,and certain other payments tax return(for interest and dividend accounts withholding.However,if the payer does not (ncludrng broker and barter exchange only),or receive your TIN from you within 60 days,backup transactions)so that you will not be subject tothe (4)You fail to certify to the payer that you are withholding will begin and continue until you 20%backup withholding that became effectivefurnish your TIN to the payer. not subject to backup withholding under(3) January I, 1914. above(for interest and dividend accounts opened Note:Writing'Applied For'on the form means Use this form to report and certify your aria 1983 only),or that you have already applied fora TIN.OR that you intend to apply for one m the near future, taxpayer identification number(TIN)to the payer, (5)You fail to certify your TIN.This applies to certify that you are not subject to backup only to interest,dividend,broker,or barter Payees and Payments Exempt Irom withholding because of underreporting interest exchange accounts opened after 1983,or broker Backup Withholding and citric]ends on your tax return,and to Wain accounts considered inactive in 1983. exemption from backup withholding if you ate an The following lists payees that are exempt from exempt payee. For other payments,you are subject to backup backup withholding and information reportsre II you do not complete withholding only if(1)or(2)above applies. For interest and dividends,all listecompleteThis form properly andpayees return it to the payer,the payer may be r Certain payees and a information rmar t onexe exempt.For broker Person payees listed in required from backup withholding and information l through to w,tnnold 20%of payments made to you. reporting.See Payees and Paymenti Exempt .( e (13),and a pArm ryista who under from Backup Withholding on this the Investment Advisers Act of 1940 who What Is Backup Withholding hgPage, regularly actssabrkerareexempt.Payments 'Exempt Payees Intl Payments under Specific subject to reporting under sections 6041 and The Interest and Dividend Tax Compliance A a of . Instructions.on page 2,if you are an exempt 6041A are pneraly exempt from backup 1983 requires payers to withhold and pay to IRS Payee withholding only if paid to payees described in 20%of payments of interest.dividends,and items(1)through(6),except that a corporation certain other payments under certain conditions. How to obtain a TIN •that provides medical and health tare services or This is called'backup withholding.'If you omt If you do not have a TIN,you should apply for ono bids and collects payments for such services is the payer your correct TIN,certify your TIN when immediately.To apply for the number obtain not exempt from backup withholding or required,and report all your taxable iMerestand Form we,Application for a Social Security information reporting.Only payees described in dividends on your tax return,your payments will Number Card(for individuals),or Ferran-4, items(2)through(6)are exempt from backup not be subject to backup withholding. Application for Employer Identification Number withholding toe barter exchange transactions, Payments you receive will be subject to (for businesses and all other entities),at your patronage dividends,and payments by certain backup withholding if: local office of the Social Security Administration fishing boat operators. or the Internal Revenue Service.Complete and file the appropriate form according to its instructions. Form 1292A Jul-85 92/;/0857 Hello