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NADOA Model Form Division Order (Adopted 9/951
renoble
energy
Return To:
Property Name :
Operator:
County / Parish and State
NOBLE ENERGY, INC
1625 BROADWAY STE 2200
DENVER CO 80202 US
LOUSTALET B 15-11 NI
NOBLE ENERGY, INC
WELD, CO
Property Description : Refer to next page for property description attachment
Product :
ALL
Desk Code :
Date :
Effective Date:
DIVISION ORDER
BSF :L...
JUL 30 2009
JUN 2008
OWNER NAME
PROPERTY #
OWNER #
INTEREST
WELD COUNTY COLORADO
435744430
124102 - 8
GWI NRI
0.00000000 0.00170430
Type RI
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
Owner(s) Signature(s):
Owner(s) Tax I.D. Number(s):
TIN(s) or SSN(s)
Owner Daytime Telephone/Fax #:
84-6000-813
970-356-4000
William F. Garcia
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.
2009-2578
7._.L2 -Etj
NOBLE ENERGY. INC. Property Description Attachment
Property Name
Operator
County / Parish and State
Property Description
: LOUSTALET B 15-11 NI
: NOBLE ENERGY, INC
: WELD, CO
T 5 N R 64W Sec. 15: E2SW
NOBLE ENERGY INC.
1625 Broadway, Suite 2200
Denver, Colorado 80202
July 30, 2009
Interest Owner
Re: Property Name : LOUSTALET B 15-11 NB
Operator : Noble Energy, Inc.
County / State : Weld Co., CO
i - -'SU\-)
Noble Energy Inc. has successfully recompleted the above referenced property in the Niobrara formation. First sales
occurred June 2008. 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. Since ownership is the same,
Niobrara production is booked with the Codell production. You will see only one entry on your check for both
formations, beginning with the date of first sales.
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, however, that payments are made upon accrual of twenty five dollars ($25.00) for all of the
properties paid to you by our company or annually, on amounts less than twenty five dollars ($25.00).
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.
l�Jc'2/ u/ de ?zc
Bernadette Foster
Land Department
303-228-4218
Desk Code: MVP
E —O O13
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.
DATE• 9-2/ / -0y
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