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NADOA Model Form Division Order(Adopted 9/951
s,,.% „ DIVISION ORDER
energy
Return To: NOBLE ENERGY,INC . Desk Code: LED
1625 BROADWAY STE 2200 . ,: Date: AUG 01 2011
DENVER CO 80202 US Effective Date: MAR 2011
Property Name: SEKICH P 19-28D CN Yzi
Operator: NOBLE ENERGY,INC S 1
County/Parish and State: WELD,CO 'l
Property Description: Refer to next page for property description attachment
Product: ALL
OWNER NAME PROPERTY# OWNER# INTEREST
%WELD COUNTY BOARD OF COUNTY COMM r1 F I 65-I(�)J-32451
Jf�245 1 435745619 124102-1 0.00070024 RI
WELD CO 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 acceded 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: !`
Owner(s)Signature(s): Barbara Kirkmeyer, Chair h,'" `2J0 2 9 2011
Owner(s)Tax I.D.Number(s): 84-6000-813
TIN(s)or SSN(s)
Owner Daytime Telephone/Fax#: 970-356-4000 X4200 970-352-0242
Address Correction: 1150 0 St
P,O. Box 758
Greeley, CO 80632
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 Noble Energy,Inc.
63.44,1"Q5,,ep c L. 2011-2334
t 6,0\k-
�. t l LEao 76-1
NOBLE ENERGY,INC. Property Description Attachment
Property Name : SEKICH P 19-28D CN
Operator : NOBLE ENERGY,INC
County/Parish and State : WELD, CO
Property Description
T3N-R67W SEC 18:SESW,SWSE;SEC 19:NENW,NWNE being 158.338 acres more or less
110 West Broadway , noble
Ardmore,OK 73401 , t. energy
Tel:580.223.4110
Fax:580.221.1364
www.nobleenergyinc.com
•
Dear Interest Owner:
Enclosed are copies of Noble Energy, Inc.'s Division Orders for your approval and execution. For
your convenience, Noble has adopted the NADOA Model Form of Division Order.
The purpose of this division order is to provide you information about your ownership and obtain
Certification from you that you are the correct person to whom payments for this interest should be
made.
Please review your decimal interest in the property described. Also review the terms of the division
order.
Supply and/or verify your Social Security or Tax Identification Number. Failure to comply will result in
a tax withholding for the Internal Revenue Service.
Supply and/or verify the address to which checks should be mailed.
The well RC number will be listed on your check detail identifying your payment for this interest. Your
party number is your identifying number with our company. Please refer to this number when
making inquiries about payments or your interest.
After your review of the enclosed division orders, please execute one copy and return to this office
for further handling. The extra copy is for your files.
Please be advised, Noble Energy, Inc. does not accept altered Division Orders. Therefore, if our
division order has been altered, Noble Energy, Inc. will still make disbursements based on the
ownership and interest stated on our division order, unless otherwise advised in writing.
Individuals-Sign your name as it appears on the Division Order.
Joint Ownership-Should be signed by all owners shown on the Division Order.
Corporations-The name of the Corporation as well as the name and title of the person signing
the document must be included.
Signature by other than named owner-If the Division Order is signed by an agent, attorney-in-
fact, guardian, trustee or any party other than the named owner, please provide a copy of the
document which authorizes him/her to sign on behalf of the owner.
Please note that the interest stated on the Division Order reflects your total owned ownership. However,
Noble Energy, Inc. may or may not disburse 100% of the proceeds.
If you should have any questions, please contact the Division Order Department at the above address.
Sincerely,
NOBLE ENERGY, INC.
Division Order Department
Note: If you would like to have your proceeds electronically deposited to your bank account, please
complete and return the enclosed direct deposit ACH Enrollment Form.
IF YOU HAVE PREVIOUSLY COMPLETED AND RETURNED
THE DIRECT DEPOSIT ENROLLMENT FORM, PLEASE DO NOT RESEND.
f_EbO1
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:
M414frer—ZA-A
ticc, Cou Attorney
DATE: c• �8 -1
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