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NADOA Model Form Division Order A pied 9/951
Great Western DIVISION ORDER
Oll L GAS COMPANY
To: Great Western Operating Company, LLC
1700 Broadway, Suite 650
Denver, CO 80290
Date: May 20, 2013
Effective Date: First Production
Property Number: 200-204 Operator: Great Western Oil and Gas
Property Name: Campbell JF 17-13D Production: X Oil, X Gas, _ Other
Property Description: T2N, R65W, 6th PM
Section 17 1'J E/4 E/4NW/4, NE/4SW/4, N_14_
County and State: Weld County, Colorado
Owner Number: WEL0001
Owner Name: Weld County Type of Interest: RI
Attn: Barb Connolly Decimal Interest: 0.03125000
PO Box 758
Greeley, CO 80632
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above
payable by Great Western Oil and Gas Company, LLC (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 $100.00, or pay annually 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:
Payor may deduct, in accordance with
this interest and pay the same on our b,
eh
statutes, ad valorem and severance taxes levied against
Owner(s) Signature(s): �l William F. Garcia Chair
Date Signed:
Owner(s) Tax ID Number(s): 84-6000-813
Owner(s) Daytime Telephone(s): 970-336-7204
Owner(s) FAX Telephone(s): 970-336-7233
Owner(s) Cell Telephone(s):
Owner(s) Email(s):
JUL 2 2 2013
wgarcia@weldgov.com
Deputy Clerk to the B
2013-
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.
-7 '3
FOR OFFICE USE ONLY:
INTEREST/FUNDS RELEASED FOR PAYMENT BY DATE:
L-fo-de _
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(s): CAMPBELL JF 17-13D File Location(s): LE0063-1
B✓ DATE: 7/?i�
Stephanie Arries
Assistant County Attorney
BEATTY & WOZNIAK, P.C.
Great Western Oil and Gas Company, LLC
Campbell JF 17-13D Well
December 20, 2012
OIL AND GAS LEASE C:
Dated:
Recorded:
Lessor:
Lessee:
Lands Covered:
Primary Term:
Royalty:
Delay Rental:
Shut-in Clause:
Pooling/Unitization Clause:
Entireties Clause:
Pugh Clause:
Special Provisions:
(100% Mineral Interest in Tract 2)
August 5, 1974
October 1, 1974 at Reception No. 1645865
Weld County, a political subdivision of the State of
Colorado, by the Board of County Commissioners
Amoco Production Company
Township 2 North, Range 65 West, 6th P.M.
Section 17: NW/4
Section 18: That part of the SE/4SE/4 described as:
Beginning at the SE corner, thence North 50
rods, thence West 36 rods; thence South 50
rods; thence East 36 rods to the point of
beginning
Section 34: That certain 200 foot strip across the SE/4,
comprising 10.16 acres, as recorded in Deed
Book 1254, Page 419
Containing 181.56 acres, more or less
Weld County, Colorado
Two (2) years from April 29, 1975, and as long thereafter...
12.50%
$181.56 per year
$100.00 per well per year
Yes, "Lessee... is hereby given the right and power to pool or
combine the land covered by this lease, or any portion
thereof, as to oil and gas, or either of them, with any other
land, lease or leases... such pooling to be in to a well unit or
units not exceeding forty (40) acres, plus an acreage tolerance
of ten percent (10%) of forty (40) acres for oil, and not
exceeding six hundred and forty (640) acres, plus an acreage
tolerance of ten percent (10%) of six hundred and forty (640)
acres, for gas, except that larger units may be created to
conform to any spacing or well unit pattern that may be
prescribed by governmental authorities having jurisdiction."
No
No
The warranty clause is stricken
"Upon the termination of this lease in whole or in part by
election or by failure to make payments as aforesaid, lessee
or his assigns shall within 30 days release by written
instrument the land or portion thereof which said lease
terminates, and said notice shall also be sent to the lessor
giving the book and page of said lease. It is expressly
Exhibit A — Page 6
BEATTY & WOZNIAK, P.C.
Great Western Oil and Gas Company, LLC
Campbell JF 17-13D Well
December 20, 2012
Extension:
understood that this lease is subject to and controlled by any
law of the State of Colorado now in effect restricting or
limiting the powers of Counties or boards of County
Commissioners and provision herein in conflict therewith
shall be inoperative and void"
Affidavits of Lease Extension were placed of record for the
subject Lease at Reception Nos. 1917306 and 3341772.
ASSIGNMENTS OF WORKING INTEREST:
Assignment No. 1
Instrument Title: Assignment and Bill of Sale
Instrument Date: January 23, 1998
Recording Data: December 1, 1997 at Reception No. 2596246
Assignor: Amoco Production Company
Assignee: HS Resources, Inc.
Lands Covered: Township 2 North, Range 65 West, 6th P.M.
Section 17: NW/4
And other lands,
Weld County, Colorado
Interest Assigned: All of Assignor's right, title and interest in the subject Lease
Interest Reserved: None
Comments: This Assignment is made in accordance with and is subject to the
terms and conditions of that certain Purchase and Sale Agreement
dated November 25, 1997 by and between Assignor and Assignee
CORPORATE MERGERS & NAME CHANGES:
1. By Certificate of Name Change and Certificate of Amendment of Restated Certificate of
Incorporation dated August 28, 2001, recorded September 4, 2001 at Rec. No. 2880658, HS Resources,
Inc. changed its name to Kerr-McGee Rocky Mountain Corporation.
2. By Certificate of Conversion from a Corporation to a Limited Liability Company dated effective
January 1, 2006, recorded April 29, 2008 at Reception No. 3550603, Kerr-McGee Rocky Mountain
Corporation changed its name and converted into Kerr-McGee Rocky Mountain LLC.
3. By Certificate of Merger dated effective June 22, 2006, recorded April 29, 2008 at Reception No.
3550604, Kerr-McGee Rocky Mountain LLC merged with and into Kerr-McGee Oil & Gas Onshore LP.
ASSIGNMENTS OF OVERRIDING ROYALTY INTEREST: None
Exhibit A — Page 7
BEATTY & WOZNIAK, P.C.
Great Western Oil and Gas Company, LLC
Campbell JF 17-13D Well
December 20, 2012
Page 7 of 33
Owner
Type of
Interest
Sandlin Oil Corporation Employee Fund ORRI
(0.50% ORM x 100.00% MI x 100.00% WI in O&GLs
A&B)
Kathie D. Sandlin
(0.50% ORRI x 100.00% MI x 100.00% WI in O&GLs
A&B)
Betty Sandlin Higbie
(4.00% ORM x 100.00% MI x 100.00% WI in O&GLs
A&B)
Grace I. Campbell
(12.50% LOR x 50.00% MI)
Gary Sandlin
(15.00% LOR x 50.00% MI)
SURFACE:
Owner
Melbon Ranch Inc.
ORRI
ORRI
LOR
LOR
WI
NRI Lease
0.000000% 0.00500000 A & B
0.000000% 0.00500000 A & B
0.000000% 0.04000000 A & B
0.000000% 0.06250000 A
0.000000% 0.07500000 B
TOTAL: 100.000000% 1.00000000
OWNERSHIP INTERESTS IN TRACT 2
(T2N, R65W, Sec. 17: SE/4NW/4)
Interest
100.00%
MINERAL INTERESTS & LEASE ROYALTY: (OIL, GAS & ASSOCIATED HYDROCARBONS ONLY)
Owner
Weld County
Mineral Lease
Interest Royalty
100.00% 12.50%
OVERRIDING ROYALTY INTERESTS: None
Lease
C
Owner
Kerr-McGee Oil & Gas Onshore LP
(100.00% WI x 100.00% MI x 87.50% NRI)
Weld County
(12.50% LOR x 100.00% MI)
SURFACE:
Owner
Melbon Ranch Inc.
BEATTY & WOZNIAK, P.C.
Great Western Oil and Gas Company, LLC
Campbell JF 17-13D Well
December 20, 2012
Page 8 of 33
LEASEHOLD WORKING INTERESTS:
Owner
Kerr-McGee Oil & Gas Onshore LP
(100.00% WI x 100.00% MI x 87.50%NRI)
Lease Lease
Working Mineral Lease
Interest Interest NRI Lease
100.00% 100.00% 87.50% C
COMBINED OIL & GAS LEASEHOLD OWNERSHIP INTERSTS FOR TRACT 2
Type of
Interest WI NRI Lease
WUNRI 100.000000% 0.87500000 C
LOR 0.000000% 0.12500000 C
TOTAL: 100.000000% 1.00000000
OWNERSHIP INTERESTS IN TRACT 3
(T2N, R65W, Sec. I7:• NE/4SW/4)
Interest
100.00%
MINERAL INTERESTS & LEASE ROYALTY: (oIL, GAS & ASSOCIATED HYDROCARBONS ONLY)
Mineral Lease
Owner Interest Royalty
Fred W. Sarchet 33.333333% 12.50%
William D. Sarchet 16.666667% 12.50%
Carol J. Sarchet 16.666667% 12.50%
Dawn Yvonne Devenney Kimball 11.111111% 12.50%
Lease
D
D
D
D
BEATTY & WOZNIAIC, P.C.
a�
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0
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0
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Tract ORRI
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0.0034179688
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OVERRIDING ROYALTY
INTERESTS ("ORRI")
Jacob L. Porter
(0.683594% ORRI x 100% MI x
100% WI Burdened x (40 acres /
160 acres)
Diamond Energy Inc.
(0.683594% ORRI x 100% MI x
100% WI Burdened x (40 acres /
160 acres)
Arjuna, LLC
(1.3671875% ORRI x 100% MI x
100% WI Burdened x (40 acres /
160 acres)
00
0
Total Overriding Royalty Interests:
a s a0
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Tract
Acres
0
0
0
0
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0
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0
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0
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0
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Lease
Royalty
e
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Lease
Mineral
Interest
e
0
0
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100.000000%
d
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LANDOWNER ROYALTY
("LOR")
Grace I. Campbell
(50% MI x 12.50% LOR x (40 acres
/ 160 acres)
Gary Sandlin
(50% MI x 15% LOR x (40 acres /
160 acres)
Weld County
(100%MIx 12.50% LORx(40
acres / 160 acres)
Exhibit C — Page 4
BEATTY & WOZNIAK, P.C.
��y a
t WO O l
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ow
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0.00341797
Tract ORRI
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00
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Acres
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Acres
O
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100.000000%
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OVERRIDING ROYALTY
INTERESTS CORRI")
Jacob L. Porter
(0.683594% ORRI x 100% MI x
100% WI Burdened x (40 acres /
160 acres)
Diamond Energy Inc.
(0.683594% ORRI x 100%MI x
100% WI Burdened x (40 acres /
160 acres)
Arjuna, LLC
(1.3671875% ORRI x 100% MI x
100% WI Burdened x (40 acres /
160 acres)
00
N
0
0
Total Overriding Royalty Interests:
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0.01562500
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LOR
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Unit
Acres
O
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O
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9
O
O
O
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Tract
Acres
O
O
O
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Royalty
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15.000000%
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Lease
Mineral
Interest
O
O
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0
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LANDOWNER ROYALTY
("LOR")
Grace I. Campbell
(50% MIx 12.50% LOR x (40 acres
/ 160 acres)
Gary Sandlin
(50% MIx 15% LOR x (40 acres /
160 acres)
Weld County
(100% MIx 12.50% LOR x (40
acres / 160 acres)
Exhibit C — Page 9
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