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Home My WebLink About20123064.tiff NADOA Model Form Division Order(Adopted 9/95) Cp) P If DIVISION ORDER SUNDANCE Return To: SUNDANCE ENERGY, INC. Property Number: CO1057 633 17th Street, Suite 1950 Date: 10/18/2012 Denver, CO 80202 Effective Date: 10/12/2012 Property Name: Lamb 31-15 Operator: Sundance Energy, Inc. County/Parish and State: Weld County, CO Property Description: NE/4, Section 15 T4N-R68W 6th P.M. Production: In Oil In Gas In Other: OWNER NAME PROPERTY# OWNER # INTEREST Weld County Commissioners CO1057 1918 RI=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 OTHER PARTIES REMAINING INTEREST The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by Sundance Energy, Inc. (Sundance). SUNDANCE 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. SUNDANCE 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 SUNDANCE any amount attributable to an interest to which the undersigned is not entitled. SUNDANCE may accrue proceeds until the total amount equals $100.00 or pay annually , whichever occurs first or as required by applicable state statutes. 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 SUNDANCE may have certain statutory rights under the laws of the state in which the property is located. Special Clauses: NONE Owner(s)Signature(s): Owner(s) Printed Name(s): Sean P. Conway, Chair OCT 29 2012 Owner(s)Address(s): 1150 0 St. P.O. Box 758 Greeley, Colorado 80632 Owner(s)TIN(s)or SSN(s): 84-6000-813 Owner(s) Daytime Telephone/Fax#: 970-336-7204 Federal Law requires you to furnish your Social Security or Taxpayer Identification Number,Failure to comply will result in 31%tax withholding and will not be refundable by SUNDANCE. AnalystiAsst: ,h7C/>' 7"[nL[ Ii/ a , �PpL ASE SIGN AND RETURN ONE DOCUMENT TO SUNDANCE ENERGY, INC. . i & 6 a .Fite/[ 7b 5 ne &L,LC(, /i • .X `J - u G /C'-99-/ RETAIN ONE COPY FOR YOUR RECORDS Legal Description: NE/4, Section 15 T4N-R68W 6`" P.M. Division of Interest OWNER NAME PROPERTY # OWNER # INTEREST Weld County Commissioners CO1057 1918 R1=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 2012-3064 NADOA Model Form Division Order(Adopted 9/95) © O P y DIVISION ORDER SUNDANCE V eaern Return To: SUNDANCE ENERGY, INC. Property Number: CO1058 633 17th Street, Suite 1950 Date: 10/18/2012 Denver, CO 80202 Effective Date: 06/29/2012 Property Name: Lamb 32-15 Operator: Sundance Energy, Inc. County/Parish and State: Weld County, CO Property Description: NE/4, Section 15 T4N-R68W 6`n P.M. Production: F-1 Oil in Gas In Other: OWNER NAME PROPERTY# OWNER# INTEREST Weld County Commissioners CO1058 1918 RI=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 OTHER PARTIES REMAINING INTEREST The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by Sundance Energy, Inc. (Sundance). SUNDANCE 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. SUNDANCE 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 SUNDANCE any amount attributable to an interest to which the undersigned is not entitled. SUNDANCE may accrue proceeds until the total amount equals $100.00 or pay annually , whichever occurs first or as required by applicable state statutes. 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 SUNDANCE may have certain statutory rights under the laws of the state in which the property is located. Special Clauses: NONE Owner(s)Signature(s): _ OCT 2 9 2012 Owner(s)Printed Name(s): Sean B. Conway, Chair Owner(s)Address(s): 1150 0 St. P.O. Box 758 Greeley, Colorado 80632 Owner(s)TIN(s)or SSN(s): 84-6000-813 Owner(s) Daytime Telephone/Fax#: 970-336-7204 Federal Law requires you to furnish your Social Security or Taxpayer Identification Number,Failure to comply will result in 31%tax withholding and will not be refundable by SUNDANCE. Analyst/Asst: PLEASE SIGN AND RETURN ONE DOCUMENT TO SUNDANCE ENERGY, INC. LL rf/•s RETAIN ONE COPY FOR YOUR RECORDS Legal Description: NE/4, Section 15 T4N-R68W 6th P.M. Division of Interest OWNER NAME PROPERTY # OWNER # INTEREST Weld County Commissioners CO1058 1918 R1=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 NADOA Model Form Division Order(Adopted 9/95) '_ °`. DIVISION ORDER SUNDANCE COPY energy Return To: SUNDANCE ENERGY,INC. Property Number: CO1059 633 17th Street, Suite 1950 Date: 10/18/2012 Denver, CO 80202 Effective Date: 10/11/2012 Property Name: Lamb 41-15 Operator: Sundance Energy, Inc. County/Parish and State: Weld County, CO Property Description: NE/4, Section 15 T4N-R68W 6t" P.M. Production: n Oil In Gas In Other: OWNER NAME PROPERTY# OWNER # INTEREST Weld County Commissioners CO1059 1918 RI=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 OTHER PARTIES REMAINING INTEREST The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by Sundance Energy, Inc. (Sundance). SUNDANCE 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. SUNDANCE 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 SUNDANCE any amount attributable to an interest to which the undersigned is not entitled. SUNDANCE may accrue proceeds until the total amount equals $100.00 or pay annually , whichever occurs first or as required by applicable state statutes. 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 SUNDANCE may have certain statutory rights under the laws of the state in which the property is located. Special Clauses: NONE Owner(s)Signature(s): c— — P (------ Owner(s) Printed Name(s): Sean P. Conway, Chair OCT 2 9 2012 Owner(s)Address(s): 1150 0 St. P.O. Box 758 Greeley, Colorado 80632 Owner(s)TIN(s)or SSN(s): 84-6000-813 Owner(s) Daytime Telephone/Fax#: 970-336-7204 Federal Law requires you to furnish your Social Security or Taxpayer Identification Number,Failure to comply will result in 31%tax withholding and will not be refundable by SUNDANCE. Analyst/Asst.: /" l�(�. PLEASE SIGN AND RETURN ONE DOCUMENT TO SUNDANCE ENERGY, INC. ')2(7/:2- LL=( /f RETAIN ONE COPY FOR YOUR RECORDS Legal Description: NE/4, Section 15 T4N-R68W 6`h P.M. Division of Interest OWNER NAME PROPERTY # OWNER # INTEREST Weld County Commissioners CO1059 1918 RI=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 NADOA Model Form Division Order(Adopted 9195) --�� CoPlf DIVISION ORDER SUNDANCE ener3 / Return To: SUNDANCE ENERGY, INC. Property Number: CO1060 633 17`h Street, Suite 1950 Date: 10/18/2012 Denver, CO 80202 Effective Date: 07/04/2012 Property Name: Lamb 42-15 Operator: Sundance Energy, Inc. County/Parish and State: Weld County, CO Property Description: NE/4, Section 15 T4N-R68W 6'h P.M. Production: n Oil n Gas n Other: OWNER NAME PROPERTY # OWNER# INTEREST Weld County Commissioners CO1060 1918 RI=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 OTHER PARTIES REMAINING INTEREST The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by Sundance Energy, Inc. (Sundance). SUNDANCE 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. SUNDANCE 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 SUNDANCE any amount attributable to an interest to which the undersigned is not entitled. SUNDANCE may accrue proceeds until the total amount equals $100.00 or pay annually , whichever occurs first or as required by applicable state statutes. 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 SUNDANCE may have certain statutory rights under the laws of the state in which the property is located. Special Clauses: NONE Owner(s)Signature(s): C. Owner(s) Printed Name(s): Sean P. Conway, Chair OCT 2 9 2012 Owner(s)Address(s): 1150 0 St. P.O. Box 758 Greeley, Colorado 80632 Owner(s)TIN(s)or SSN(s): 84-6000-813 Owner(s) Daytime Telephone/Fax#: 970-336-7204 Federal Law requires you to furnish your Social Security or Taxpayer Identification Number,Failure to comply will result in 31%tax withholding and will not be refundable by SUNDANCE. Analyst/Asst: •9(7.2— PLEASE SIGN AND RETURN ONE DOCUMENT TO SUNDANCE ENERGY, INC. RETAIN ONE COPY FOR YOUR RECORDS Legal Description: NE/4, Section 15 T4N-R68W 6th P.M. Division of Interest OWNER NAME PROPERTY # OWNER # INTEREST Weld County Commissioners CO1060 1918 RI=0.00150625 1150 O Street, P.O. Box 758 Greeley, CO 80632 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: County Attorney DATE: /7 23- lZ SUNDANCE October 18, 2012 energy Weld County Commissioners 1150 O Street, P.O. Box 758 Greeley, Colorado 80632 Re: CO1057-Lamb 31-15 CO1058-Lamb 32-15 CO1059-Lamb 41-15 CO1060-Lamb 42-15 Motocross Prospect Weld County, Colorado Owner No. 1851 Dear Interest Owner: Enclosed are Sundance Energy's Division Orders covering your interests in the captioned properties. Please follow the instructions below to ensure the Division Orders are properly executed. 1. Verify your name and address and make any necessary changes. 2. Division Orders for corporations must be executed by an authorized officer 3. As required by Federal law, please provide your Social Security Number and/or Tax Identification Number in the space provided. 4. Please refer to your owner number above when making inquiries about your payments or your interest. A self-addressed stamped envelope is enclosed for your use in returning one fully executed copy of each Division Order to me. The Division Orders stamped "COPY" are for your files. Sundance issues payments on or about the 15th of each month. Please refer to the Division Order regarding minimum payments. If you have any questions regarding your interest or if any of the information is incorrect, please contact me directly at 720-708-6006. Kind re ards, Sund n 1Energy, Inc. ovotney Land Records Manager • mn/Enclosures 633 17th Street Suite 1950 Denver. CO 80202 Office 303.543.5700 Fax 303.543.5701 www. danceenergy.net Hello