HomeMy WebLinkAbout970392.tiff NADOA Model Form Division Order(Adopted 9/95)
OIL & GAS DIVISION ORDER
To: K P Kauffman Company, Inc. Date: January 15, 1997
1675 Broadway, Suite 1970 Effective Date: January 1, 1997
Denver, CO 80202
Property Number 616
Property Name: MCGILL#1 ORIGINAL
Operator K. P. KAUFFMAN COM PANY, INC.
County and State: WELD, COLORADO
Property Description TOWNSHIP 1 NORTH, RANGE 65 WEST, SECTION 2: NW/4NE/4
Owner Name and Address:
Weld County Colorado
Board of County Commissioners
P.O. Box 758
Greeley, CO 80632
FOR DIVISION OF INTEREST
SEE EXHIBIT"A"ATTACHED HERETO AND MADE A PART HEREOF
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 terms and conditions of this Division Order,the undersigned and Payor may have certain
statutory rights under the laws of the state in which the property is located.
Special Clauses:
George E. Baxter, Chair
Owner(s)Signature: ��r Weld County Board of Commissioners
Owner(s)Tax ID Number(s) 84-6000813
Owner Daytime Telephone#: (970)356-4000. ext.4225
Owner FAX Telephone#: (970)352-0242
Federal Law requires you to Armish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 31%tax withholding and will not be refundable by Payor.
BD MTG.
01/27/97 2531094 B-1589 P-378 01/29/1997 10:35A PG 1 OF 2 REC DOC LE0061
Weld County CO JA Suki Tsukamoto Clerk & Recorder 0.00 970392
EXHIBIT"A"
ATTACHED HERETO AND MADE A PART HEREOF THAT CERTAIN OIL & GAS
DIVISION ORDER DATED JANAURY 15, 1997, FROM K. P. KAUFFMAN COMPANY
MCGILL#1 - PROPERTY#616
NWNE SEC 2-1N-65W
WELD COUNTY, COLORADO
INTEREST WORKING NET REVENUE
OWNER# NAME AND ADDRESS: TYPE INTEREST INTEREST
600062 WELD COUNTY COLORADO RI .059425300
600064 KATHERN H. BOWERS RI .004598250
600067 WILMA G. HARDIMAN RI .006428600
600068 JERRY M. IRELAND RI .000205750
600069 H. THOMAS IRELAND RI .000205750
600071 MARGARET F. KENT RI .006428600
600072 JOHN L. MCGILL RI .012857200
600073 PHILLIPS PETROLEUM COMPANY RI .000605500
600074 VINTHA CRYSTAL REYNOLDS RI .004598250
600075 ALICE THELMA SPAYD RI .004598250
600076 ARLIE MARIE SWAN RI .004598250
600077 MAXINE WARREN RI .001646000
600078 ROBERT G. WARREN RI .000411500
600079 KEITH H. HEIMBUCK RI .021763400
600080 CARL BAESSLER, JR. RI .018389000
600063 GEORGE R. SHIARELLA, TTEE ORRI .021763400
600065 RICHARD N. DODGE ORRI .001764300
600066 DOUBLE EAGLE PET. &MINING CO ORRI .029712700
8000 K. P. KAUFFMAN COMPANY, INC. WI 1.000000000 .800000000
TOTAL 1.000000000 1.000000000
2531094 8-1589 P-378 01/29/1997 10:35A PG 2 OF 2
l/0 fri
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.
1,
BY:
unty A orn y
DATE: it >
Hello