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AUTHORIZATION TO RECEIVE OIL AND DIRECTION FOR PAYMENT
TO: TEXACO TRADING AND TRANSPORTATION INC. ( TTTI )
Lease Ownership
Post Office Box 5568
Denver, Colorado 80217-5568
Toll Free 1-800-992-8470
Lease No. 053970
Date: AUGUST 18, 1997
•
Effective at 7:00 A.M. JULY 1, 1997 and until the first day of the month following thirty (30) days advance written notice of
change of ownership or termination, you are authorized to receive the production of the undersigned from the following described
lease in accordance with your agreement with the lease operator:
MARK T BROWN
KINDT #1 LEASE
located in WELD County, State of COLORADO
described as:
TOWNSHIP 7 NORTH - RANGE 57 WEST
SECTION 11: NE/4 NW/4
The undersigned warrants to ITI1 ownership of the interest indicated below next to their name in the oil produced and saved from the
above lease and directs TTTI to distribute payment for such oil as provided below.
CREDIT TO OWNER NUMBER: 000053723 TYPE: ROYALTY INTEREST: 0.1250000
TRANSFERRED FROM: 999999999
CURRENT INTEREST(S) IN PAY STATUS FOR THIS LEASE:
WELD COUNTY CLERK TO. THE BOARD
PO BOX 758
GREELEY CO 80832-0758
CONFIRMATION
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In the event of a dispute concerning title to any portion of the proceeds of this interest 1111 may ho d the proceeds until it receives
evidence of tit e satisfactory to 1 I'll. The undersigned agrees to notify TITI in writing of any change in the decimal interest and all
changes shall be effective the first day of the month following 1111's receipt of such notice. For any claims arising from the undersigned's
failure to provide written notice, the undersigned will fully indemnify and hold TTTI harmless. If action or inaction by the undersigned
causes TIT1 to over -pay this interest, then ITI1 may recoup the overpaid amount from the undersigned's interests in other leases.
Finally, all payments shall be subject to all present and future laws, regulations and orders.
SIGNAT RE OF OJR(S),�
X A �
GEO E. BAXTER, CHAIR aC/x'1/9%
WELD COUNTY BOARD OF COMMISSIONERS
X
SOCIAL SECURITY OR TAX ID NUMBER
84-6000813
PAYMENT FOR THIS INTEREST SHOULD BE SENT TO:
WELD COUNTY CLERK TO THE BOARD
PO BOX 758
GREELEY, CO 80632
DAYTIME TELEPHONE NUMBER ( 970 ) 356-4000x4225 CORRESPONDENCE AND IRS FORM 1099 SHOULD BE SENT TO:
El Please check if these are NEW ADDRESSES and apply to all
leases with this owner number.
ITPI ROUTING:
RECD
N/A
SUSPENSE
D of I
ANALYST.
7567156
B-1624
P-475
09/04/1997 11:4',
AS ABOVE
A PG I OF 3 REC
ZIP + 4 (
DOC
972237
CON Weld County CO
JA Suki Tsukamoto Clerk S Recorder 0.00 LE0130
TEXACO TRADING AND TRANSPORTATION INC.
CUSTOMER SERVICE
Office Hours 6:30 A.M. - 4:30 P.M. (MST)
Telephone: 1-800-992-8470 FAX: (303)860-3699
WELD COUNTY CLERK TO THE BOARD
PO BOX 758
GREELEY CO 80632-0758
AUGUST 18, 1997
Dear Interest Owner,
The enclosed Authorization Document has been prepared on the basis of documentation provided.
Please examine the Authorization Document for accuracy. If you agree with the interest set forth,
execute the original, retaining the copy provided for file and future reference. A correct mailing
address and Social Security or Tax Identification number are required and should be included in the
spaces provided. The executed original should then be returned to our office. We have included a
self-addressed envelope for your convenience.
If the fully executed Authorization is received in our office on or before the end of the month, we
will release payment for prior purchases on the 20th day of the following month, providing that the
accruals to the interest amount to at least $25.00.
Please refer to our lease number and your owner number in any communications with our company
so that we can respond promptly.
FOR YOUR INFORMATION
Payments will be made monthly for oil received during the previous month unless the amount due is
less than $25.00. Amounts of less than $25.00 will be accumulated and paid when the total either
equals or exdeeds $23.00 or at such time during each fiscal year when all amounts due of $5.00 or
more are released to owners whose accounts are in pay status. Amounts due of less than $5.00, will
be released when requested by owner.
Please send written notice of any name or address change to:
Lease Ownership / Name and Address, P.O. Box 5568, Denver CO 80217
Be sure to indicate your owner and tax identification numbers
2567156 B-1624 P-475 09/04/1997 11:47A PG 2 OF 3
u53970
000053723 WELD COUNTY
000323544 BROWN MARK T
000345561 U S OIL LLC
000352478 KETO ENERGY LL C
R 0.1250000
W 0.52,50000
W 0.1750000
W 0.1750000
2567156 B-1624 P-475 09/04/1997'11:47A PG 3 OF 3
4,147
COUNTY ATTORNEY
STAFF APPROVAL
This is to affirm the attached
Division Order or 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
applicable.
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