HomeMy WebLinkAbout961489.tiff NADOA Model Form Division Order(Adopted 9/95)
</3 OIL & GAS DIVISION ORDER
To: K P Kauffman Company, Inc. Date: JUNE 20, 1996
1675 Broadway, Suite 1970 Effective Date: JANUARY 1, 1996
Denver, CO 80202
Property Number 337
Property Name: WELD COUNTY UNIT#1
Operator: K.P. KAUFFMAN COMPANY
County and State: WELD, COLORADO
Property Description Township 2 North Range 66 West Section 18: NW/SW
Owner Name and Address: OWNER NUMBER 1890
WELD COUNTY COLORADO BOARD OF Royalty Interest .01243200
COMMISSIONERS
POST OFFICE BOX 758 Overridiing Royalty Interest
GREELEY, CO 80632 Working Interest
Net Revenue Interest
The undersigned certifies the ownership of their decimal interest in production or proceeds as described
above payable by K P Kauffman Company, Inc. (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 term-=r!�y�,y��,r *•i- of this Division Order, the undersigned and Payor may have
certain statutory ri•��' �'S�_• the state in which the property is located.
Special Clauses:,ast . ° �`,
M
� ��1
��q.. BARBARA J. KIRKMEYER, CHAIR
Owner(s)Signat 17: .4i-01 :►� WELD COUNTY BOARD OF COMMISSIONRS
Owner(s)Tax ID N `4-6000813
Owner Daytime Telephone#: (970)356-4000 EXT.4225
Owner FAX Telephone#: (970)352-0242
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comely will result in 31%tax withholding and will not be refundable by Payor.
2500213 8-1555 P-519 07/09/96 04:30P PG 1 OF 2 REC D0C
LE0082 Weld County CO Clerk & Recorder 0.00
CONSENT AGENDA 07/03/96
961489
WELD COUNTY UNIT#1
NW/SW-18-2N-66W
NET REVENUE WORKING
CREDIT INTEREST INTEREST
WELD COUNTY COLORADO 0.01243200 RI
RAY M. ROBERTS 0.02814000 RI
ROBERT M. STAHL 0.01243200 RI
CANNON MINERALS LLC 0.07199000 RI
CANNON MINERALS LLC 0.07199000 ORR
HS RESOURCES, INC. 0.00994600 ORR
K.P. KAUFFMAN COMPANY, INC 0.03023700 ORR
K.P. KAUFFMAN COMPANY, INC 0.76283300 NRI 1.00000000 WI
1.00000000 1.00000000
2500213 B-1555 P-519 07/09/96 04:30P PG 2 OF 2
Page 1
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.
BY:
County Att y --
r_
DATE: 6:- 1 = l Jq-
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