HomeMy WebLinkAbout961359.tiff TOTAL PETROLEUM, INC. DIVISION ORDER
515 CENTRAL PARK DR, STE 200 LGT / 02 /
OKLAHOMA CITY, OK 73105 DATE: 05/24/1996
LISA TEAGUE BREWER EFFECTIVE: 05-01-96
(405) 557-7064 LEASE NO. : 00064133-500
___ = = __________=====s = =a==
The undersigned warrants ownership of their net revenue decimal interest,
as set forth below, in the production of hydrocarbons, from the:
BRANDLY OILMAN CONSULT -- NELSON J 33-23 (GAS)
lease insofar as said lease covers the following described real property
situated in the County of WELD, State of CO, to wit :
N/2 SECTION 33-5N-67W.
(FOR THE PURPOSE OF THIS DOCUMENT, THE LEGAL DESCRIPTION MAY BE ABBREVIATED. )
The undersigned also warrants that ownership is in conformity with the lease
agreement and state and federal laws. Proceeds will be paid to the undersigned,
whose address and tax ID are listed below. by Total Petroleum, Inc. (TOTAL) ,
monthly (or when $25 or more accrues) . Written notice of ownership or operator
change must be given to TOTAL at least 30 days prior to the intended effective
date. All changes will be made effective the first daac the month following
the end of said notice period.
TOTAL is authorized to suspend payment, without liability for interest, until
resolution of any title question, dispute, or claim which affects the
undersigned, who agrees to refund to TOTAL any amount attributable to an
interest the undersigned does not own and to indemnify and hold harmless TOTAL
for all payments made pursuant to this Division Order. Upon request by the
operator, TOTAL is authorized by the undersigned to deduct leasehold operating
expenses (only if same is a participating or pooled working interest owner) ,
for payment to the operator who will provide detailed statements.
TOTAL PETROLEUM INC. WILL BE DISBURSING THE GAS PROCEEDS EFFECTIVE 5-01-96.
DO NOT DETACH
OWNER NUMBER: 03-092769 DECIMAL INTER
�I�R1t 219 RI
TAX ID/SOCIAL SECURITYtl:
84-6000813 %70 )356-4000 ext. 4225
K:rkmeyer, Chair
1681 . ,
OWNER SIGNATURE(S) : ��l ,_. �. s i a`° �� ",� •.
P7 ; � ';
„� W �, P k Thtt o o e
ATTES , V�ieputy Cork to the Board
RETURN THIS COPY TO TOTAL PETROLEUM INC. ESS SHOWN ABOVE.
PLEASE INDICATE ANY ADDRESS CHANGES ON THE LINES BELOW:
WELD COUNTY Weld County Board of Commissioners
BOARD OF COUNTY COMMISSIONERS 915 10th Street
WELD COUNTY CENTENNIAL CENTER P.O. Box 758 961359
915 10TH ST Greeley. CO 80637
GREELEY CO 80631-1123 — --
2495368 B-1550 P-953 06/07/96 04:39P PG 1 OF 2 RE DOC
LE0008 Weld County CO Clerk & Recorder 0C.00
Board Meeting 06/03/96
TOTAL PETROLEUM, INC.
515 CENTRAL PARK DR, STE 200
OKLAHOMA CITY, OK 73105
LISA TEAGUE BREWER
(405) 557-7064
INSTRUCTIONS TO ALL INTEREST OWNERS
ENCLOSED IS OUR DIVISION ORDER, IN DUPLICATE, FOR YOUR EXECUTION. THIS
DIVISION ORDER SHOWS THE INTEREST WHICH IS BEING CREDITED TO YOU AND THE
LEGAL DESCRIPTION OF THE PROPERTY FROM WHICH PRODUCTION IS BEING OBTAINED.
PLEASE RETURN THE FULLY EXECUTED DIVISION ORDER, WITHOUT DELAY, TO THE ADDRESS
SHOWN ABOVE. RETAIN ONE COPY (YOUR COPY) FOR YOUR OWN RECORDS.
(READ CAREFULLY BEFORE SIGNING THE ENCLOSED DIVISION ORDER. )
SIGNATURE: Sign your name as shown on the enclosed Division Order.
Please type or print your name below your signature
together with your current address and social security
number or taxpayer identification number. If you are
already receiving checks from this company, please be
certain to use the same address to which we are now
mailing checks. WITNESSES ARE NOT REQUIRED.
SOCIAL SECURITY OR Please provide your social security or taxpayer
TAXPAYER identification number. Failure to furnish this number
IDENTIFICATION will result in a 31X backup withholding tax in accordance
NUMBER: with federal income tax law and may subject you to a
$50.00 penalty by the I.R.S.
LEASE NUMBER: The lease number that appears on the enclosed Division
Order will appear on the detail attached to your check
and should always be used when corresponding with this
company.
ADDRESS CHANGE: 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 owner number (which appears on your
check from this company) and your old address. Then
state your new address with zip code.
SUSPENSE: If a "requirement" appears on the Division Order, you
should take whatever steps are called for to clear the
title problems so the interest can be released for
payment .
CHECKS: A check will be issued by Total Petroleum when $25.00
or more is accrued for a particular owner in a lease.
THE DIVISION ORDER SHOULD NOT BE ALTERED IN ANY WAY UNLESS ACCOMPANIED BY
DOCUMENTATION SUPPORTING THE ALTERATION.
2495368 B-1550 P-953 06/07/96 04:39P PG 2 OF 2
491
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, 1
applicable.
BY: L
County Attorney
DATE:
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