HomeMy WebLinkAbout20042270.tiff DIVISION ORDER
Tp: Prima Oil &Gas Company Date: July 13, 2004
' y1099 18th Street, Suite 400, Denver, CO 80202 Effective Date: First Production
Property Number 231010
Well Name: Berg Farms 19-21
Operator: Prima Oil &Gas Company ®�
County and State: Weld County, COLORADO S.
Property Description: T6N, R65W, 6th P.M., Section 19: N/2NW(NENW) CO P
Production: Oil X Gas X Other
Owner Name and Address: Owner Number:
SEE EXHIBIT"A"ATTACHED HERETO Type of Interest:
Decimal Interest:
The undersigned certifies the ownership of their decimal interest in production or proceeds as described on
Exhibit"A" payable by Prima Oil &Gas Company(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 hold Payor harmless from and against any and all liability, loss,
costs, damage and expenses (including, but not limited to, attorneys' fees, court costs and interest at the
statutory prejudgment rate on funds improperly paid to the undersigned), relating to or in any way arising from
from payments made under this Division Order, including payments mistakenly made to the undersigned, or
otherwise attributable to the interest in production claimed by the undersigned. In the event of any mistake in
such payments made to the undersigned, the undersigned shall immediately refund such payments to Payor.
Payor may accrue proceeds until the total amount equals$25.00, or pay once a 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 Payor may have certain
statutory rights under the laws of the state in which the property is located.
Special Clauses: None ATTEST: iiiteltitp /
1A WELD COUNTY CLERK E a RD
Owner(s) Signature: S)(5--ci
� i ten.
Robert D. Masden, Chair •
Owner(s)Tax ID Number(s) 84-6000-813 ' ,�` r � E BOARD
JUL 2 6 20! � ` �.
r � .'
Daytime Telephone No. (970)356-4000 X4200 Witness: lscl , r •v. `t, -a:
FAX Telephone No. (970) 352-0242 Witness: ` I
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Federal Law requires you to furnish your Social Security or Taxpayer Identificati I
Failure to comply will result in 31%tax withholding and will not be refundable Jt,E"C'
8-3-aoof CGS trim 2 a;/ 2004-2270
EXHIBIT "A"
DIVISION ORDER NO: 231010 WELL: BERG FARMS 19-21
PAGE 1 OF 2
INT. EFFECT. EFFECT. REC DIST CRE SUS WPT ST EXEMPT PAY
OWNER NO/NAME TYPE DATE TO DESCRIPTION PERCENT REV BILL ENT CDE CDE 1 2 3 4 5 TO
000001 PRIMA OIL & GAS COMPANY WI 02/01/2003 12/01/9999 OIL .78851926 Y Y Y 00 NNNNN
1099 18th STREET SUITE 400 NO NET AIR GAS .78851926 Y Y Y 00 NNNNN
DENVER CO 80202 AD VALOREM .78851926 Y Y y
00 NNNNY
LEASEHOLD 1.00000000 N Y
BEFORE CASI 1.00000000 N Y
AFTER CABIN 1.00000000 N Y
OPERATING C 1.00000000 N Y
101187 H&C COLTON COMPANY ORRI 02/01/2003 12/01/9999 OIL .00192149 Y Y Y 1 00 NNNNN
621 17TH ST STE 1320 GAS .00192149 Y Y Y 1 00 NNNNN
DENVER CO 80293 AD VALOREM .00192149 Y Y Y 1 00 NNNNN
101605 FRANK WILSON III ORRI 02/01/2003 12/01/9999 OIL .00576447 Y Y Y 6 00 NNNNN
1187 COAST VILLAGE ROAD, #I-496 MONTECITO CA 93108
GAS .00576447 y y y 6 00 N N N N N
kADOIL VALOREM .00576447 Y V Y 6 00 N N N N N
10 WELD COUNTY BOARD OF COUNTY RI 02/01/2003 12/01/9999
COMMISSIONERS .00296036 Y Y Y 1 00 NNNNN
WELD COUNTY CENTENNIAL CENTER GAS .00296036 Y Y Y 1 00 NNNNN
915 10TH ST AD VALOREM .00296036 Y Y Y 1 00 NNNNN
GREELEY CO 80632
102844 BILL J. HALL ORRI 02/01/2003 12/01/9999 OIL .01000000 Y Y Y 1 00 NNNNN
32712 VISTA LAKE ROAD GAS .01000000 Y Y Y 1 00 NNNNN
GREELEY CO 80631 AD VALOREM .01000000 Y Y Y 1 00 NNNNN
105735 PATINA OIL & GAS CORPORATION ORRI 02/01/2003 12/01/9999 OIL .02556313 Y Y Y 6 00 NNNNN
1625 BROADWAY, SUITE 2000 GAS .02556313 Y Y Y 6 00 NNNNN
DENVER CO 80202 AD VALOREM .02556313 Y Y Y 6 00 NNNNN
106240 PATCHEN FAMILY PARTNERS, LTD. ORRI 02/01/2003 12/01/9999 OIL
5175 SHAVANO COURT .00866023 Y Y Y 1 00 NNNNN
WINDSOR GAS .00866023 Y Y 1 00 NNNNN
CO 80550 V AD VALOREM .00866023 Y Y Y 1 00 NNNNN
109917 BERG FARMS, LLC RI 02/01/2003 12/01/9999 OIL .06126045 Y Y Y 1 00 NNNNN
P.O. 00X 148 GAS .06126045 Y Y Y 1 00 NNNNN
LUCERNE CO 80646 AD VALOREM .06126045 Y Y Y 1 00 NNNNN
110019 JOHN G. BRANT,TTE/TST 8/6/82 ORRI 02/01/2003 12/01/9999 OIL
DOUSSARD, BRANT, HODEL & MARKMAN .00162379 Y Y Y 1 00 N N N N N
710 KIPLING, SUITE 305 GAS .00162379 Y Y Y 1 00 NNNNN
LAKEWOOD AD VALOREM .00162379 Y Y Y 1 00 NNNNN
CO 80215
110020 THEODORE D. SHELDON ORRI 02/01/2003 12/01/9999 OIL .01462982 Y Y Y 1 00 NNNNN
4310 S. LAFFAYETTE, CH HLS VLG GAS .01462982 Y Y Y 1 00 NNNNN
ENGLEWOOD CO 80113 AD VALOREM .01462982 Y Y Y 1 00 NNNNN
110021 ROBERT L. ARMANTROUT ORRI 02/01/2003 12/01/9999 OIL .00324759 Y Y Y 1 00 NNNNN
P 0 BOX 2767 GAS .00324759 Y Y Y 1 00 NNNNN
LONGBEACH CA 90801 AD VALOREM .00324759 Y Y Y 1 00 NNNNN
110022 H&I INVESTMENTS, LTD. ORRI 02/01/2003 12/01/9999 OIL .00375264 Y Y Y 1 00 NNNNN
7657 EAST VIA DE VENTURA GAS .00375264 Y Y Y 1 00 NNNNN
SCOTTSDALE AZ 85258 AD VALOREM .00375264 Y Y Y 1 00 NNNNN
110023 BRADLEY K. LEAFGREN ORRI 02/01/2003 12/01/9999 OIL .00112578 Y Y Y 6 00 NNNNN
970 HAWKRIDGE COURT GAS .00112578 Y Y Y 6 00 NNNNN
EATON CO 80615 AD VALOREM .00112578 Y Y Y 6 O0 N N N N N
EXHIBIT "A"
DIVISION ORDER NO: 231010 WELL: BERG FARMS 19-21 PAGE 2 OF 2
INT. EFFECT. EFFECT. REC DIST CRE SUS WPT ST EXEMPT PAY
OWNER NO/NAME TYPE DATE TO DESCRIPTION PERCENT REV BILL ENT CDE CDE 1 2 3 4 5 TO
110024 J CLEO&JAMES JR THOMPSON PARTNERSH ORRI 02/01/2003 12/01/9999 OIL .00150106 Y Y Y 1 00 NNNNN
1487 VAIL VALLEY DRIVE GAS .00150106 Y Y Y 1 00 NNNNN
VAIL CO 81657 AD VALOREM .00150106 Y Y Y 1 00 NNNNN
110299 MONFORT ENERGY RESOURCES, INC. RI 02/01/2003 12/01/9999 OIL .04699242 Y Y Y 1 00 NNNNN
P. 0. BOX "G" GAS .04699242 Y Y Y 1 00 NNNNN
GREELEY CO 80631-9425 AD VALOREM .04699242 Y Y Y 1 00 NNNNN
110300 PUBLIC SERVICE COMPANY OF COLORADO RI 02/01/2003 12/01/9999 OIL .00021463 Y Y Y 1 00 NNNNN
ATTENTION: LEE GUSTAVSON GAS .00021463 Y Y Y 1 00 NNNNN
550 FIFTEENTH STREET, SUITE 1000 AD VALOREM .00021463 Y Y Y 1 00 NNNNN
DENVER CO 80202-4256
110301 MICHAEL B. WILLITS RI 02/01/2003 12/01/9999 OIL .02226288 Y Y Y 1 00 NNNNN
P. 0. BOX 5354 GAS .02226288 Y Y Y 1 00 NNNNN
GREELEY CO 80634 AD VALOREM .02226288 Y Y Y 1 00 NNNNN
NET NET REVENUE INTEREST NET 00/00/0000 12/31/9999 OIL 1.00000000
GAS 1.00000000
AD VALOREM 1.00000000
TOTALS PRODUCTS WORKING NET WI NET REV ROYALTY OVERRIDES WI+RI+OR EXPENSES
OIL .78851926 1.00000000 .78851926 .13369074 .07779000 1.00000000 LEASEHOLD 1.00000000
GAS .78851926 1.00000000 .78851926 .13369074 .07779000 1.00000000 BEFORE CASING POINT 1.00000000
AFTER CASING POINT 1.00000000
AD VALOREM .78851926 1.00000000 .78851926 .13369074 .07779000 1.00000000 OPERATING COSTS 1.00000000
\\1.. 11/,
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Prima Oil & Gas Company
July 13, 2004
TO: Interest Owners
Re: Berg Farms 19-21 (231010)
N/2NW(NENW) Section 19-T6N-R65W
Weld County, CO
Ladies and Gentlemen:
Prima Oil & Gas Company (as"OPERATOR") recently drilled and completed the above referenced well in
which you own an interest. Therefore, enclosed are two (2) identical original Division Orders, for your
further handling. Please follow the procedures on the enclosed Instruction Sheet and return one (1) fully
executed Division Order to my attention in the postage paid envelope. The second original is for your
files.
NOTE: YOUR INTEREST WILL REMAIN IN SUSPENSE PENDING RECEIPT OF THE FULLY
EXECUTED DIVISION ORDER.
If you should have any questions or concerns, please do not hesitate to call me at 303-297-2300
(extension 212). Thank you for your cooperation to our request.
Very truly yours,
PRIMA OIL&GAS COMPANY
Jet L. Frase
Senior Division Order Analyst
/jlf
Enclosure
1099 18'"Street • Suite 400 • Denver, Colorado 80202
Office: 303.2972300 • Fax: 303.2977708 • www.primaenergy.com
INSTRUCTIONS TO INTEREST OWNERS
This instrument should not be altered in any way unless accompanied by documentary evidence
supporting the change.
If name and interest are correctly shown:
1. Interest owner should sign as shown on the instrument as it reflects record title. If owner's
name has changed, please alter the Division Order when executing it and attach a copy of the
marriage certificate, divorce decree, change of name certificate or other supporting document.
2. All individual signatures should be witnessed by two disinterested and unrelated parties.
3. For joint interest or life estate interests, execution should include signatures of all joint owners
or remaindermen, as appropriate.
4. If signed by agent, attorney-in-fact, or any party other than the named interest owner, evidence
of the rights vested in the signatory party must be furnished (if not already furnished).
5. All partners must sign for a partnership unless signature is that of an authorized partner, and a
certified copy of his authority must be furnished (if not already furnished).
6. For a limited liability company or similar entity, the signature of the signing party must be duly
authorized by the entity and a certified copy of his authority must be furnished (if not already
furnished).
7. If the signature is that of an officer of a corporation, the signature must be attested, title of
signatory party shown and corporate seal affixed.
8. Verify address to which checks are to be mailed and make corrections if necessary. (If a
subsequent change of address is necessary, please notify us promptly in writing, including your
Owner Number, which appears on your check).
9. Tax Identification Number or Social Security Number must be inserted in the space provided.
The Internal Revenue Service requires that we withhold 31% of the proceeds payable to any
owner who does not furnish such number. If qualified under Federal Regulation as TAX
EXEMPT, copy of Certification of Tax Exemption should be furnished.
RETURN ONE FULLY EXECUTED INSTRUMENT PROMPTLY TO THE ADDRESS BELOW
KEEP THE OTHER COPY FOR YOUR RECORDS.
Prima Oil &Gas Company
1099 18th Street, Suite 400
Denver, CO 80202
Attention: Janet L. Frase
(303) 297-2300 -- FAX (303) 297-7708
Checks will be issued by our accounting department monthly upon receipt of the fully executed Division
Orders. Revenue checks are normally mailed out around the 20th of each month. However, funds will
be held until the account totals $25.00 and/or on an annual basis.
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 applic
BY:
Co Attorney
DATE: 7 la=
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