HomeMy WebLinkAbout20131529.tiffNADOA Model Form Division Order (Adopted 9/95)
DIVISION ORDER
To: PDC Energy, Inc.
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Jenni L Muller (303) 831-3914 or Jenni.Muller@pdce.com
Property Number:
Property Name:
Operator:
County and State:
Property
Description:
Production:
105.100771
Simonsen 1 L-421
PDC Energy, Inc
Weld, Colorado
Township 6 North, Range 67 West
Section 12: NENW (spaced W/2 — 318.758 acres)
Oil
X
Gas
X
Date: May 20, 2013
Effective Date: March 20, 2013
Other: all products
Owner Name
and Address:
Weld County Colorado Board Of City Commissioners
Po Box 758
Greeley, CO 80632
OWNER NUMBER: 68541
Type of Interest: RI
Decimal Interest: 0.00023592
(0.376/318.758*100%*20%) (Tract 1, Block 1, Lot 1)
(Net Acres/Acres in Spacing Unit k` % 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 S50.00, 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.
Special Clauses:
Owner(s) Signature(s):
(None or See.9rr!Ietl F_.xhibit)
JUN 17 2013
Owner(s) SSN/Tax I.D. Number(s): 84-6000-813
Owner Daytime Telephone: 970-335-7204
Owner Email Address: wgarcia@weldgov.com
William F. Garcia, Chair
Attest: 1'\
Clerk to the'aard
By.
Deputy CleriE'to the Boa
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
Retain this copy for your records
Le —l7 —l3
2013-1529
ZS,— 4.3:5
FYIA
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:
BY:
Simonsen 1L-241NB
NB
Simonsen 1L-421
Stephanie Arries
Assistant County Attorney
File Location(s): LE0315
DATE: /l 7)
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.
2 of 3
Exhibit I
SOUTHWEST QUARTER SECTION 1, TOWNSHIP 6 NORTH,
RANGE 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
ar
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SCALE
1" = 500'
FRANKLIN LAKE FARM
OWNER (FLF)
HKS ENTERPRISE LLC
AREA OF UNKOWN OWNERSHIP
SEE NOTE N5
FELTS, DEBORAH K.
BORNHOFT, ANNETTE
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.
303
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