HomeMy WebLinkAbout993018.tiff DO'REA /IAA-)/us
OMAR/026450/0221176
(KEEP THIS COPY FOR YOUR RECORDS)
NIUUIH HHIOIII H' IllHHIHI
DIVISION ORDER
To' Plains All American Inc., For the Accounts of Plains Marketing, L.P.and Scurlock Permian LLC Owner Number
P.O. Box 4648
Houston,TX 77210-4648 Date: 12/15/1999 0221176
Property Descr: SEE EXHIBIT'A'
Property Name: BLEHM 30-1 Effective 7 A.M.: 11/01/1999 Property Number:
Operator: SOUTHWESTERN PRODUCTION CORP 01 099039
County and State: WELD, CO Decimal Interest: 0.00375000
Production OIL/CONDENSATE(GAS) Type of Interest: RI
ROYALTY INTEREST
Owner Name WELD COUNTY COLORADO WELD COUNTY COLORADO
and Address. C/O BOARD OF COUNTY C/O BOARD OF COUNTY
COMMISSIONERS COMMISSIONERS
WELD CNTY CENTENNIAL CENTER WELD CNTY CENTENNIAL CENTER
PO BOX 758 PO BOX 758
GREELEY, CO 80632 GREELEY,CO 80632
[Correspondence Address] [Remittance Address]
The undersigned severally and not jointly certifies the ownership of their decimal interest in production or proceeds as described above payable by Plains All American Inc.,For the Accounts of Plains
Marketing,L P.and Scurlock Permian LLC(hereinafter called"Payer').
Payer 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 asserted regarding the interest in production claimed herein by the undersigned. The undersigned agrees to
reimburse Payor any amount attributable to an Interest to which the undersigned is not entitled. Unless otherwise required by law,Payer shall not be required to pay interest on payments withheld due to
atitle dispute or adverse claim
Payments of less than$25.00 may be accrued before disbursement until the total amount equals$25.00 or more,or until December 31 of each year,whichever occurs first.
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.
The undersigned will be paid in accordance with the division of interests set out above. As to oil and/or condensate,the Payor shall pay all parties at the price agreed to by the operator for oil and/or
condensate to be sold pursuant to this division order. Payor shall compute quantity and make corrections for gravity and temperature and make deductions for impurities. As to gas,the undersigned will
be paid in accordance with the division of interest set forth herein. The Payor will pay all parties for their respective interest in the gas proceeds paid to Payor by the operator for disbursement at the price
and upon the terms agreed to by the operator for the gas marketed by the operator. Payor is a disbursement service provider only and does not purchase the gas nor take title to the gas. The operator is
responsible for marketing gas produced from the property described in the attached property description. Payor does not assume any obligations of the lessee or operator under any oil and gas lease,
gas sales contract or other agreement to which Payor is not a party.
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/Requirements: If applicable,see Exhibit'A'.
Owner Social Security#
or Taxpayer ID#: 84-6000813
Owner Daytime Telephone#: (970)356-4000 x4200 -,
Owner FAX#: (970)352-0242__
Signature of two / ^vs ,
Owner BY: ( Witnesses/Attest La ► `r r 1,
Signature: OWNER#: 0221176 Clerk to the Board • t-
•
(19 Ii
nrL ,sE.Dale K. Hall, Chair. Weld County By: i ' • •''
Board of Commissioners ( / - ;1?-`3r7\) Deputy Clerk to the Bo. 7151UNic,
L
FEDERAL LAW REQUIRES YOU TO FURNISH YOUR SOCIAL SECURITY OR TAXPAYER IDENTIFICATION NUMBER.
FAILURE TO COMPLY WILL RESULT IN 31%TAX WITHHOLDING AND WILL NOT BE REFUNDABLE BY PAYOR.
F
993018
LE0l'10
DOPRBAT/JMO/us
991206015504
(KEEP THIS COPY FOR YOUR RECORDS)
EXHIBIT 'A'
PROPERTY NUMBER: 01 099039
OWNER: 0221176
OWNER NAME/ADDRESS SSN/TIN INTEREST TYPE PAY ST EFFECTIVE CLAUSES REQUIREMENTS
0221176 WELD COUNTY COLORADO 84-6000813 0.00375000 RI 4N 11/01/1999 1 N/A
CIO BOARD OF COUNTY
COMMISSIONERS
WELD CNTY CENTENNIAL CENTER
P O BOX 758
GREELEY,CO 80632
CLAUSES
1 AS A COURTESY WE HAVE PLACED YOUR WORKING INTEREST DIRECTLY IN LINE FOR PAYMENT. WE, THEREFORE,
REQUEST YOU EXECUTE AND RETURN THE DIVISION ORDER AT YOUR EARLIEST CONVENIENCE. IF WE HAVE NOT
RECEIVED YOUR PROPERLY EXECUTED COPY WITHIN 30 DAYS, THE INTEREST WILL BE SUSPENDED.
LEGAL DESCRIPTION
sw/4 SE/4 section 30, TOWNSHIP 6 NORTH,
RANGE 64 WEST, WELD COUNTY, COLORADO.
Page 1 (Exhibit A)
C DPF BAT I d,,O I us
WELD COUNTY COLORADO OWNER NUMBER: 0221176
C/O BOARD OF COUNTY
COMMISSIONERS
WELD CNTY CENTENNIAL CENTER
P 0 BOX 758
GREELEY, CO 80632
j
INSTRUCTIONS TO ALL INTEREST OWNERS
READ CAREFULLY BEFORE SIGNING DIVISION ORDER.
FAILURE TO COMPLY WITH THESE INSTRUCTIONS WILL DELAY PAYMENT. THE ATTACHED DIVISION ORDER SHOULD NOT BE:ALTERED IN
ANY WAY UNLESS ACCOMPANIED BY DOCUMENTARY EVIDENCE TO SUPPORT THE CHANGE.
7 •
Signature:
Individuals
Sign name as shown on the instrument. Have the signature witnessed by at least one person not related to the party signing.
Corporations
If signing for a corporation,signature must be attested,corporate seal affixed,and title of signatory party shown. If not previously furnished,
a certified copy of authority of executing officer must be submitted.
Partnerships
If signing for a partnership,all partners must sign unless signed by an authorized partner and a certified copy of his authority furnished.
Signature by Second Party
If the instrument is signed by an agent,attorney-in-fact,guardian,estate representative,trustee or any party other than the named interest owner,
evidence of the rights vested in the signatory party must be provided.
Taxpayer ID or Social Security Number
Insert your number in the space provided. Failure to provide this information may result in backup withholding at the rate of 31%. This
information must be shown on this Division Order even if it has been previously provided.
State Tax Exempt
Please advise immediately if the interest is owned by a tax-free entity and provide our office with a copy of the applicable state form. State taxes will
be deducted if you fail to enclose documentation supporting your tax-exempt status.
Correspondence Address
Indicate in the space provided the address to which correspondence is to be mailed. Print or type. Do not abbreviate.
Remittance Address
Indicate in the space provided the address to which royalty checks are to be mailed. If you are already receiving checks from SPLLC,be sure to use the
same address to which we are now mailing checks. For information about electronic deposit of your check,please call our Customer Relations
Department toll free at 1-800-772-7589.
Change of Address
You should notify us promptly of any change in your mailing address. Please call our toll free Customer Relations line for assistance at
1-800-772-7589.
RETURN THE EXECUTED DIVISION ORDER PROVIDED TO THE ADDRESS BELOW.
KEEP ONE COPY FOR YOUR RECORDS.
Plains All American Inc., For the Accounts of Plains Marketing, L.P.and Scurlock Permian LLC
Attention: Revenue Distribution
P.O. Box 4648
Houston,TX 77210-4648
PLEASE NOTE THAT AN IMPROPERLY EXECUTED DIVISION ORDER WILL NOT BE PROCESSED FOR PAYMENT AND WILL BE RETURNED FOR
PROPER EXECUTION.
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