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NADOA Model Form Division Order(Adopted 9/95
rNa noble DIVISION ORDEI
YIELD COUNTY
ell 0r9Y "MMISSI0IdERS
Return To: NOBLE ENERGY, INC 1011 MAR 1 b q n. r. sk
14 2012 Code: JBC 115774
NO BOX OE
110 W BROADWAY Effective Date: JUN-2008
ARDMORE OK 73402 US jECEf VED
Property Name: GEISERT F 02-16 CN V
Operator: NOBLE ENERGY, INC
County/Parish and State: WELD, CO
Property Description: Refer to next page for property description attachment
Product: ALL
OWNER NAME PROPERTY# OWNER# INTEREST
WELD COUNTY COLORADO 435662392 124102-1 0.00888750 RI
%BOARD OF COUNTY COMM
WELD CO CENTENNIAL CENTER
1150 O STREET
GREELEY CO 80632 US REVISED
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Noble Energy, Inc.(Noble).
Noble 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.
Noble 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 Noble any amount attributable to an interest to which the undersigned is not entitled.
Noble may accrue proceeds until the total amount equals$25, or pay proceeds with a balance of $10 or more annually in September of each year,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 Noble may have certain statutory rights under the laws of the state in which the
property is located.
Special Clauses:
Dwner(s)Signature(s): &IC At-rest:
Sean P. Conway, Ch �y! O< Clerk o the B rd
Dwner(s)Tax I.D.Number(s): G 4
rIN(s)or SSN(s) 84-6000-813 �S.�i411' B : lL�. AR `
Deputy Clerk to the Board Ve
Dwner Daytime Telephone/Fax#: 970-356-40000 970-352-0242 -`
1!
"4
lddress Correction: 1t6
11
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.Failure to comply will result in tax withholding In accordance with
federal;law,which will not be refundable by Payor. _
&O/o? -0289
� . , on.cp �o Noble CL O458
3- a3Ia-
NOBLE ENERGY.INC. Property Description Attachment
Property Name : GEISERT F 02-16 CN
Operator NOBLE ENERGY,INC
County/Parish and State : WELD, CO
Property Description
T5N R65W SEC 2:E2SE,CONTAINING 80 ACRES,MORE OR LESS,WELD COUNTY,CO
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, legal description, and percentage
of royalties, if applicable.
BY: A/2/41,14-e-
c„.,, ;fr- County Attorney
DATE: 3 /�
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