HomeMy WebLinkAbout20130356.tiffNADOA Model Form Division Order (Adopted 9/95)
DIVISION ORDER
To: Bonanza Creek Energy Inc.
410 17'h Street Suite 1400
Denver, CO 80202
Attn: Susan Merezko
Property Number: CO007209
Property Name: NORTH PLATTE X-D-35HZ
Operator: Bonanza Creek Energy Operating
County and State: Weld, Colorado
Property No legal description on file
Description:
Production:
Oil
X
Date: December 13, 2012
Effective Date: September 1, 2012
Gas Other:
RECEIVED
JAN 2 5 2013
WELD COUNTY
COMMISSIONERS
Owner Name and Address:
WELD COUNTY BOARD OF COMMISSIONERS
P 0 BOX 758
GREELEY, CO 80632-0758
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Bonanza
Creek Energy 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 asserted 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 $100.00, or pay yearly whichever occurs first, or as required by applicable
state statute.
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.
OWNER NUMBER: 1041
Type of Interest: RI
Decimal Interest: 0.00024389
Special Clauses:
Owner(s) Signature(s):
WELD COUNTY BOARD OF COMMISSIONERS
Owner(s) Tax I.D. Number(s): 84-6000-813
(None or See Attached Exhibit)
William F. Garcia, Chair
C
Owner Daytime Telephone
Owner FAX Telephone #:
970-336-7204
970-352-0242
FEB 0 4 2013
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
SNM
Retain this copy for your records
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INSTRUCTIONS TO ALL INTEREST OWNERS
Dear Interest Owner,
Bonanza Creek Energy Inc. has enclosed a Division Order for your execution.
The attached document should not be altered in any way except to correct spelling errors, unless accompanied by
documentary evidence to support the change.
If your name and interest are correctly shown:
1. Sign your name as shown on the Division Order.
2. If your name has changed due to marriage or divorce, execute the Division Order using your present name and furnish a copy
of the marriage certificate or divorce decree.
4. If signing for a corporation, signature must be attested, corporate seal fixed and title of signatory party reflected.
5. If signed by agent, attorney -in -fact, guardian or any party other than the named interest owner, a certified copy of the power
of attorney or other evidence of such party's right to sign must be furnished.
6. Your correct mailing address should be noted in the space provided to insure prompt receipt of production proceeds.
7. The top copy or the "Original" of the Division Order should be returned to:
Bonanza Creek Energy Inc.
410 17th Street Suite 1400
Denver, Colorado 80202
Attn: Susan Merezko
8. Should you have any further questions regarding the enclosed Division Order, please contact Bonanza Creek Energy at (720)
440-6177.
9. Please DO NOT DETACH the exhibit from the Division Order or Transfer Order if one is included.
COGIS - WELL Information
COGIS - WELL Information
Scout Card I Related Q Insp. Q MIT • GIS C]a Doc 11 Wellbore
Surface Location Data for API # 05-123-36033
Well Name/No: North Platte #34-35 (click well name for production)
Operator: BONANZA CREEK ENERGY OPERATING COMPANY LLC - 8960
Status Date: 8/28/2012 11:57:59 AM Federal or State Lease #:
County: WELD #123 Location:
Field: WATTENBERG -#90750 Elevation:
Planned Location 1941 FSL 834 FEL Lat/Long: 40.35425/-104.39706
Wellbore Data for Sidetrack #00
Wellbore Permit
Permit#:
Prop Depth/Form: 6940
Mineral Owner: FEE
Unit: Unit Number:
Formation and Spacing: Code: NB -CD , Formation: NIOBRARA-CODELL , Order: GWA , Unit Acreage: 40, Drill Unit: SWSE
Casing: String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 410, Weight: 24
Cement: Sacks: 170, Top: 0, Bottom: 410, Method Grade:
Casing: String Type: 1ST, Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 6940, Weight: 11.6
Cement: Sacks: 170, Top: 6000, Bottom: 6940, Method Grade:
Wellbore Completed
Completion Date: N/A
Measured TD:
True Vertical TD:
Top PZ Location: Sec: 35 Twp: 5N 63W
Bottom Hole Location: Sec: 35 Twp: 5N 63W
Formation Log Top
No additional interval records were found for sidetrack 00.
DIRECTIONAL
Expiration Date:
Surface Mineral Owner Same:
Surface Owner:
Page 1 of 1
11 Orders
Status: XX
NESE 35 5N 63W 6 PM
4,522 ft.
Lat/Long Source: Field Measured
Status: XX 6/13/2012
8/27/2014 11:57:59 AM
N
FEE
Measured PB depth:
True Vertical PB depth:
Footage: 660 FFSLL 1980 FFELL Depth
Footages: 660 FFSLL 1980 FFELL Depth
Log Bottom
Cored
DSTs
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12336033&type=WELL 1/25/2013
COUNTY ATTORNEY STAFF APPROVAL
This is to affirm the attached Division Order and authorization to receive
payment for an oil and gas well has been reviewed by the County
Attorney's staff as to form and legal description.
tic
Assis : nt County Attorney
Date of signature: /-2 / /3
Additional Comments:
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