HomeMy WebLinkAbout20102496.tiff 4 ^37 I ,ISion 'J::O c1Y
DIVISION ORDER
To: Great Western Oil and Gas Company, LLC Date: October 12, 2010
1700 Broadway, Suite 650ij Effective Date: First Production
Denver, CO 80290
Property Number 200-120 & 200-121 - Operator Great Western Oil and Gas
Property Name: HEINZE 31-13 &31-14 Wells Production: X Oil, X Gas,_Other
Property Description: T7N, R63W, 6th PM, Sec. 31: W'/2SW'/,
County and State: Weld County, Colorado
Owner Name: Weld County Board of Commissioners Owner Number WEL0002
Address: P O BOX 758 Type of Interest: NRI
Greeley, CO 80632 Decimal Interest: 0.12500000
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 $25.00, 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 applicable statutes, ad valorem and severance taxes levied against
this interest and pay the same on our behalf.
Owner or Manager's Signature: Q
OCT 1 8 2010
Please print name: Doug as Radehacher, Chair
Company's Tax ID Number: 84-6000-813 '7 3I-13 Apt b5-123-9267
Telephone: 970-356-4000 Ext 4200 ((
FAX Telephone: 970-352-0242 Op L( [� I
Email: drademacher@co.weld.co.us Int 3)-I t �` 105123 —P 2Iq `
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.
FOR OFFICE USE ONLY
INTEREST/FUNDS RELEASED FOR PAYMENT BY DATE:
2010-2496
Santiago Rodriguez
1700 Broadway Petroleum Landman -
Suite 650 x i " r Tel: 303-398-0596
Denver, Colorado 80290 Fax: 1-866-776-1057
ph- 4 E-mail: srodriguez@gwogco.com
October 12, 2010
Weld County Board of Commissioners
P.O. Box 758
Greeley, CO. 80632
Re: Division Orders for: Heinze 31-13 & 31-14 Division Orders for: Heinze 31-23 & 31-24
T7N-R63W, Section 31: W''SW'/ T7N-R63W, Section 31: E1/2SW1/4
Weld County, Colorado Weld County, Colorado
Division Orders for: Heinze 31-33 & 31-43
T7N-R63W, Section 31: N''SE'/
Weld County, Colorado
Ladies and Gentleman:
Please find enclosed two copies each of the Division Orders for the above referenced wells. Please fill-in and
sign one of the copies of the Division Orders and then return the signed Division Orders in the enclosed self
addressed envelope. Please retain the second copy of each Division Order for your records.
Upon receipt of your executed Division Orders, Great Western will place your interest in line for payment,
effective with the first date of production from the Heinze 31-13, 31-14, 31-23, 31-24, 31-33 & 31-43 wells.
Royalty checks are cut and mailed around the middle of each month.
If you have any questions or concerns regarding the enclosed documents, please feel free contact me.
Best Regards,
Great Western Oil & Gas Company
Santiago Rodrigue2/~J
Petroleum Landman
Enclosures
070/e-074/y6
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: zea
Coun Attorney
DATE:
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