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NADOA Model Form Division Order (Adopted 9/95)
In a b l e DIVISION ORDER ttgcte
energy
Return To: NOBLE ENERGY, INC Desk Code : JSO 123335
1625 BROADWAY STE 2200 Date : SEP 25 2012
DENVER CO 80202 US Effective Date: APR 2012
' , RECEIVED
Property Name : WAHLERT AC 33-66IQN, I
Operator : NOBLE ENERGY, INC SEP 27 2011
County / Parish and State : WELD, CO
API O5- 123 - 34517 WELD COUNTY
Property Description : Refer to next page for property description attachment COMMISSIONERS
Product ALL
OWNER NAME PROPERTY # OWNER # INTEREST
WELD COUNTY COLORADO 435815046 124102 - 8 0.12500000 RI
BOARD OF COUNTY COMMISSIONER
WELD COUNTY CENTENNIAL CENTER
PO BOX 758
GREELEY CO 80632 US
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 $25.00, or clear ALL payable proceeds in January 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. RETAIN FOR YOUR RECORDS
Special Clauses: R . ? RECORDS _ /),
Owner(s) Signature(s): Sean P . Conway , Chair -....)
Owner(s) Tax LD. Number(s): 84-6000-813 - j r 03 2012
TIN(s) or SSN(s) Attest :
Jerk to e Boyd a-
Owner Daytime Telephone/Fax #: 970-336-7204 i '�'aI ,€)Address Correction : Deputy Cler to the Bo d roe ?i
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Federal Law requires you to furnish your Social Security or Taxpayer Identification Number. Failure to comply will result in tax withholding in.accaD1anoetvith
federal law, which will not be refundable by.Payor.
2012-2822
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2,6-007 yo
NOBLE ENERGY.INC. Property Description Attachment
Property Name : WAHLERT AC 33-66HZ NI
Operator : NOBLE ENERGY,INC
County/Parish and State : WELD, CO
Property Description
T7N R63W SEC 33:N2,CONTAINING 323.46 ACRES MORE OR LESS,WELD COUNTY,CO
NOBLE ENERGY INC.
1625 Broadway, Suite 2200
Denver,Colorado 80202
September 25,2012
Interest Owner
Re: Property Name : WAHLERT AC 33-66HZ NI
Operator : Noble Energy, Inc.
County/State : Weld, CO
Noble Energy Inc.has successfully completed the above referenced property. First sales occurred May 4,2012.
According to our records, the interest shown on the attached division order represents your total share of production.
Noble will tender payment to you based upon the stated interest UNLESS you notify Noble,in writing that said interest
is incorrect or that you are not the owner of said interest.
As the owner of the above interest, you shall have the sole liability to notify Noble, in writing, of any address changes
and/or changes in ownership. Until such written notification is received by Noble, payments will continue as
previously described.
Please be advised that Noble does not require a signed Division Order as a prerequisite for payment. This Payment
Letter is intended to replace the traditional division order form and should be retained for your records.
If there are any questions concerning this matter,please contact the undersigned.
Jordan Olson
Land Department
720-587-2202
Desk Code: Garrett
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: � ' /244,4e l
c / County Attorney
DATE: 912 �� `
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