HomeMy WebLinkAbout20131528.tiffNADOA Model Form Division Order (Adopted 9/95)
REVISED DIVISION ORDER
To: PDC Energy, Inc. Date: June 4, 2013
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Jenni L Muller (303) 831-3914 or Jenni.Muller(7a,pdce.com
Spud Date: December 22, 2012
151 Date of Production: March 18, 2013
Property Number: 105.100770
Property Name: Simonsen 1L-241 NB
Operator: PDC Energy, Inc
County and State: Weld, Colorado
Property Township 6 North, Range 67 West
Description: Section 12: NWNW (spaced Section 1: W2; Section 12: N2NW —398.758 unit acres)
Production:
Owner Name OWNER NUMBER: 68541
and Address:
Weld County Colorado Board of City Commissioners Type of Interest: RI
PO Box 758 Decimal Interest: 0.00018859 (Block 1, Lot 1)
Greeley, CO 80632 (0.376/398.758*100%*20%)
(Net Acres/Acres in Spacing Unit * % of net acres * Royalty Interest)
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC
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 $50.00, 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.
X
Oil
X
Gas
X
Other: all products
Special Clauses:
Owner(s) Signature(s):
(Note/or/pc . tb hed Exhibit)
JUN 17 2013
Owner(s) SSN/Tax I.D. Number(s): 84-6000-813
Owner Daytime Telephone:
Owner Email Address:
970-336-7204
wgarcia@weldgov.com
William F. Garcia, Chair
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 28 % tax withholding and will not be refundable by Payor
JLM
Gil+
Le 7-13
Retain this copy for your records
cejt;it-4, P.DG
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2013-1528
03/5-
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PDC
ENERGY
Corporate Office
1775 Sherman Street. Suite 3000
Denver, CO 80203
303-88O.5800
yaw pdce can
June 3, 2013
Weld County Colorado
Board of City Commissioners
PO Box 758
Greeley, CO 80832
Re: Revised Division Order — Simonsen 1L-241
Dear Interest Owner:
Enclosed are two copies of our Division / Transfer Order for the above referenced well. The
division orders have been revised, as they originally had the incorrect spacing unit. These
division orders reflect the correct interest.
Please follow the enclosed "Instructions to Interest Owners" for executing and returning
one copy of the Division / Transfer Order to this office. The extra copy is for your records.
The cut-off for changes in accounting is the 10th of the month. If we receive your Division
Orders after the 10th, the pay change will take place the following month.
If you have any questions pertaining to the calculation of your interest on the Division /
Transfer Order, please feel free to contact me by e-mail at Jenni.Mullent3)odce.com or by
phone at 303-831-3914. Changes in ownership or address should also be directed to my
attention. If you have questions pertaining to revenue or revenue checks, please contact
the Revenue Department at the Bridgeport Office.
Sincerely,
PDC Energy, Inc.
`� (-YVI&
Jenni L. Muller
Division Order Analyst
/Jim
enclosures
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.
Well Name:
Simonsen 1L-241NB
Simonsen 1L-421
File Location(s): LE0315
BY: A//ydas t DATE:
Stephanie Arries
Assistant County Attorney
Township 6 North, Range 67 West,
Section 1 & Section 12
Simonsen 1L-241 - spaced Section 1: W/2 & Section 12- N/2NW/4
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Weld County, Colorado
Exhibit I
NORTHWEST QUARTER, SECTION 1, TOWNSHIP 6 NORTH,
RANGE 67 WEST, OF THE 6TH P.M.
COUNTY OF WELD, STA TE OF COLORADO.
FRANKLIN LAKE FARM
OWNER (Elf)
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GREEN MOUNTAIN SURVEYING
SAMUEL A. KNIGHT
1195 EDINBORO DR.
BOULDER, CO 80305
303-601-8588
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F>c)21S(1"\
HUNTER HILL SU8DIVISSON
PHASE
HUNTER HILL SU$DIVISION
SECOND FILING
HUNTER HILL PATIO HOMES
FRANKLIN'S ADDITION
TO THE TOWN OF SEVERANCE
THIS IS NOT A LAND SURVEY PLAT OR A BOUNDARY SURVEY
NO MONUMENTS WERE SET
SEE NOTES ON PAGE 1
PAGE 2 OF 12
PROJECT LOCATION:
SECTION 1, TOWNSHIP 6 NORTH,
RANGE 67 WEST, 61H P.M.
2 o1 3
Exhibit I
SOUTHWEST QUARTER SECTION 1, TOWNSHIP 6 NORTH,
RANCE 67 WEST, OF THE 6TH P.M.
COUNTY OF WELD, STATE OF COLORADO.
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GREEN MOUNTAIN SURVEYING
SAMUEL A. KNIGHT
1195 EDINBORO DR.
BOULDER, CO 80305
303-601-8588
SCALE
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FRANKUN LAKE FARM
OWNER (FLF)
HKS ENTERPRISE LLC
AREA OF UNKOWN OWNERSHIP
SEE NOTE #5
mraal FELTS. DEBORAH K.
-- 1,.
BORNHOFT, ANNETIE
THIS IS NOT A LAND SURVEY PLAT OR A BOUNDARY SURVEY
NO MONUMENTS WERE SET
SEE NOTES ON PAGE 1
PAGE 4 OF 12
12
SEE NOTE *5
PROJECT LOCATION:
SECTION 1, TOWNSHIP 6 NORTH,
RANGE 67 WEST. 6TH P.M.
30!3
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