HomeMy WebLinkAbout20011126.tiff OIL AND GAS DIVISION ORDER
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OPERATOR: HS RESOURCES, INC. Date: C Apt Ill 7/2001•
1999 BROADWAY,SUITE 3600 Effective Date: Date of First Production
DENVER, CO 80202 Well Numbern I99035fle jM 2: t7
(303)296-3600 °< v.; ,c r.it _I
Well Name: HSR-MILLER FEDERAL#15-6A I )g
U
Description: T2N R66W,SEC.6: S/2 �LJJ
Formation: J Sand
County and State: Weld, Colorado
Owner: Address: Decimal Interest:
WEL210 Weld County Board of 915 10th Street 0.00070770 RI
Commissioners Greeley, CO 80632
The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by HS RESOURCES,iNC.
HS RESOURCES, INC. shall be held harmless in the event of, and is hereby released from any and all damage or loss which might arise out of any
overpayment. The Owner executing this Division Order, in consideration of payments by HS RESOURCES, INC., agrees to pay any overriding royalty
or royalty owners and/or all other persons who may have right, title or interest in the interest in production set out above and further agrees to protect,
indemnify and hold HS Resources, Inc.harmless from and against any and all loss, cost or expense which it may suffer or sustain by reason of such
payment regardless of how any such claim or demand may arise, including all costs or expenses incurred by HS Resources, Inc. in defending its
position in any such claim,suit or action.
The undersigned agrees to notify HS RESOURCES, INC., 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.
HS RESOURCES, INC. 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 HS RESOURCES, INC.any amount attributable to
an interest to which the undersigned is not entitled.
HS RESOURCES, INC. may accrue proceeds until the total amount equals twenty-five dollars ($25.00), or pay annually, 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 HS RESOURCES, INC. may have certain statutory rights under the
laws of the state in which the property is located.
The undersigned authorizes HS RESOURCES, INC.to withhold from the proceeds of any and all production referred t.,�1'-�' �T.y t of any tax
placed thereon by any governmental authority and to pay the same on our behalf.
Witnes /•
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Owner(s)Signature(s): (t% O 42a1
G ro tbA
L
M. J. Geile, Chair (04/23/2001) �s[� t61r � W
reputy wlerk to��
Owner(s)S.S. or Tax I.D.# 84-6000-813
Owner Daytime Telephone# (970)356-4000 X4200
Owner Fax Telephone# (970)352-0242
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 Payor.
2001-1126
EXHIBIT "A"
HSR-MILLER FEDERAL#15-6A
T2N, R66W Sec.6:S/2
321.48 Acres --- - ------
J Sand Formation
Well#990350
Owner Decimal Interest
Number 'Owner Name I Mailing Address Interest Interest Calculation Type
2996 25th Street
BRA330 g e Scott Bragg Boulder, CO 80304-2808 0.01986910 2/3 x .50 MI x 125 RI x 153.30/321.48 acres II RI
'George
HS Resources, Inc. 10.00414330 j RI
HS Resources, Inc. 10.85373160 NRI
'
HS Resources, Inc. I 10.00894110 ORR
10952 Hwy 85
KU N945 Kunzman Family, LLC Fort Lupton, CO 80621-9602 0.014430.70 2/3 MI x .125 RI x 55.67/321.48 acres RI
Franz R. Kunzman and Carmie Kunzman, 1359 E. Ginter I
KUN955 joint tenants Tucson,AZ 85706 0.00721530'I 1/3 MI x .125 RI x 55.67/321.48 acres', RI
Longmont United Hospital Foundation P. O. Box 1159
LON357 First National Bank of Longmont,Agent Longmont, CO 80502-159 10.00993440 1/3 x.50 MI x .125 RI x 153.30/321.48 acres RI
3250 Ocean Park Blvd.-Suite 140
MAC345 Machii-Ross Petroleum Company Santa Monica, CA 90405 0.00596070 .025 ORR x .50 x 153.30/321.48 acres) ORR
9 Holdings Hess Land Holdin s LLC, a Colorado limited 4000 E. Belleview Ave. I
,liability company Greenwood Village, CO 80121 0.01490180 .50 x .50 MI x .125 RI x 153.30/321.48 acres RI
12251 WCR 22 1/2
Minerals Management Service P.O. Box 5810-MS652 .50 MI x .125 RI x 154.96/321.48 acres) RI
— -- '
MIL531 Elton N. Miller and Catherine S. Miller Ft. Lupton, CO 80621 0.03012620
MIN275 Royalty Management Program Denver, CO 80217-5810 0.00946020'. 1.00 MI x .125 RI x 24.33/321.48 acres'. RI
1357 43rd Ave., Unit#15
QIO559 Thomas F. and Mildred L. Quinn,joint tenants Greeley, CO 80634-2444 _I 0.01490180 .50 x .50 MI x A 25 RI x 153.30/321.48 acres! RI_
P. O. Box 843169
UNI660 IUnion Pacific Resources Co. Dallas,TX 75284-3169 0.00567610 .075 ORR x 24.33/321.48 acres ORR
915 10th Street
WEL210 Weld County Board of Commissioners Greeley, CO 80632 I 0.00070770 1.00 MI x .125 RI x 1.82/321.48 acres RI
TOTAL 1.00000000'
Page 1
HS RESOURCES, INC 1 '__?
1999 BROADWAY, SUITE 3600 DENVER, COLORADO 80202
(303) 296-3600 • ;,!`I I !!1 n. i
FACSIMILE (303) 296-3601
RCS., -_; b
INSTRUCTIONS FOR EXECUTION OF OIL AND GAS DIVISION ORDERS
Please read the following instructions carefully before signing the enclosed division order:
1. Be sure that your interest is correct.
2. Sign your name in the space provided exactly as it is shown BEFORE TWO
WITNESSES.
3. Your SOCIAL SECURITY NUMBER or TAX IDENTIFICATION NUMBER must be
shown in the space provided. Failure to provide the number may result in a 31%
withholding of your production proceeds, as required by law, and you also could be subject
to a penalty imposed by the Internal Revenue Service. Also enclosed is an IRS Form W-9,
please complete and return this form so that we will have it for our records. ( For new
owners only)
4. Show the address to which checks should be mailed.
5. If the interest is owned by a CORPORATION,the division order must be signed by a duly
authorized officer and attested. The corporate seal must be affixed and the title of the
signing officer shown.
6. If the interest is owned by a PARTNERSHIP, the division order must be signed by the
general partner or managing partner and evidence of such authority to sign must be
furnished.
7. If the division order is signed by anyone other than the named owner such as an AGENT,
ATTORNEY-IN-FACT,or GUARDIAN, evidence of authority must be provided.
After you have completed and signed the division order, please return the original to us. The copy
is for your records.
Should you have any questions,please do not hesitate to call.
WENDY HOPKINS
HS RESOURCES,INC.
1999 BROADWAY, SUITE 3600
DENVER, CO 80202
(303) 296-3600
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: J
? — � 1- z_
County ttor ey /
DATE: Ti H
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