HomeMy WebLinkAbout20012740.tiff OIL AND GAS DIVISION ORDER
OPERATOR: HS RESOURCES, INC. Date: August 28,2001
1999 BROADWAY,SUITE 3600 Effective Date: Date of,Firsf,Produgtipr}-_, r,
DENVER,CO 80202 Well Number: 110020' — i ;: -
(303)296-3600
Well Name: HSR—CANNON 9—18A
Description: T2N R66W,SEC. 18: S/2
Formation: J Sand
County and State: Weld,Colorado
Owner: Address: Decimal Interest:
WEL210 WELD COUNTY BOARD OF 915 10TH STREET 0.00494822 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*filth ft 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($25.00), or pay annually,whichever occurs first, or as
required by applicable state statute.
This Division Order does not amend any lease or operating agreement between the undersigned and the lessee or operator or any other contracts for
the purchase of oil or gas.
In addition to the terms and conditions of this Division Order,the undersigned and HS RESOURCES,INC.may have certain statutory rights under the
laws of the state in which the property is located.
The undersigned authorizes HS RESOURCES, INC.to withhold from the proceeds of any and all production referred to h �.-Et ;.i tax
placed thereon by any governmental authority and to pay the same on our behalf. U.d�� `ar,Wit angs/ tte$t• I18 0 �-'
Owner(s)Signature(s): ? U.lsi '� •. ,'.J/'% 'f
RI 4
M. J. Geile, Chair (09/19/01) /J: i I7 .
Deputy Clerk to the sb±T..1 Hist'4
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.
2001-2740
EXHIBIT "A"
•
HSR-CANNON 9-18A _
_ T2N,R66W
SEC.18:S/2 --- _
326.38 ACRES,M/L
J Sand Formation
WELL#110020 -
OWNER DECIMAL INTEREST
NUMBER OWNER NAME_ MAILING ADDRESS INTEREST TYPE
I 974 WCR 16
BEA776 DARRELL L.BEARSON AND NELVA M.BEARSON FT.LUPTON,CO 80621 0.00294902 RI
36 STEELE ST.#250
CAN566 CANNON LAND COMPANY DENVER,CO 80206 0.07926727 RI
_
36 STEELE ST.#250
CAN566 CANNON LAND COMPANY DENVER,CO 80206 0.07926727 ORR
P.O. BOX 536
6505 E. 160TH AVE.
DEG261 MARCUS A.DEGENHART BRIGHTON,CO 80602-6006. .. 0.00033958 ORR
80 SOUTH 27TH AVENUE
FAR520 FARMERS RESERVOIR&IRRIGATION CO. BRIGHTON,CO 80601 0.00203750 RI
J.P.FIELD ESTATE 1414 BANK ST:
FIE520 CIO M.F.BOUDREAU,EXECUTOR LAKE CHARLES,LA 70601-6206 0.00013244 RI
GROUND WATER MGMT SUBDISTRICT OF THE
CENTRAL COLORADO WATER CONSERVANCY 3209 W.28TH ST.
GRO853 DISTRICT _ GREELEY,CO 80634. 10.000356181 RI
6386 WELD COUNTY RD.23
HEI503 [RICHARD L. HEIN FORT LUPTON,CO 80621 0.00750391 RI
_
6196 S.CARSON ST.
HIL400 BOB HILL ENGLEWOOD,CO 80111 0.00033958 ORR
805 MEADOW RUN
H00852 MATTHEW R.IiOOVLER GOLDEN,CO 80403 0.00033958 ORR _
HSR001 HS RESOURCES, INC. - 0.78186546 NRI
HSR001 HS RESOURCES, INC. 0.01060727 ORR
129 NORTH 4TH AVENUE
JUR327 EILEEN J.JURGENSEN BRIGHTON,CO 80601 0.00831088 RI
JUR326 SHANNON JURGENSEN ADDRESS UNKNOWN 0.00207772 RI
P.O.BOX 3248
MCC855 MCCULLISS RESOURCES CO.,INC. LITTLETON,CO 80161-3248 I 0.00103885 RI
7311 MONROE -
SHO770 LOIS G.SHORT MISSION,TX 78572 _ __ 0.00415543 RI
BRADY LANDON NELLIS AND CHRISTINE J. 13420 BRAUN RD.
SMITH,JTS GOLDEN,CO 80401 0.001859411 RI
[9378 WCR 25
STA350 ROBERT M.STAHL AND MARY E.SHAHL,JTS FT.LUPTON,CO 80621 0.00350244 RI
SUN004 SUN OPERATING LIMITED PARTNERSHIP ADDRESS UNKNOWN 0.00210881 ORR
P.O.BOX 13557-
VAU335 GEORGE G.VAUGHT,JR. DENVER,CO 80201-3357 0.00103885 RI
915 10TH STREET
WEL210 (WELD COUNTY BOARD OF COMMISSIONERS GREELEY,CO 80632 0.00494822 RI
C/O PETERSON MGMNTCO INC.
7586 WEST JEWELL AVE.#202
WEL268 WELCO VENTURE LAKEWOOD,-CO 80235-2309 0.00595433 RI
TOTAL:11.00000000
Page 1
HS RESOURCES, INC.
1999 BROADWAY, SUITE 3600
DENVER, COLORADO 80202
(303) 296-3600
FACSIMILE (303) 296-3601
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
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