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Home My WebLink About20012737.tiff OIL AND GAS DIVISION ORDER Date: August 28,2001 1999 OPERATOR: RESOURCES, INC. Effective Date: Date of First Production DENVER,BR CO 80202 SUITE 3600 7 CO Well Number 610500 - � /- + � `' (303)296-3600 ._ , I."t,_ ,_ Well Name: CLC GU#2 Description: T2N R66W,SEC. 18:S/2 Formation: J Sand(Revised 8/16/01) County and State: Weld,Colorado Owner: Address: Decimal Interest: 0.00494822 RI 15 10TH COMMISSIONERS WEL210 WELD COUNTY BOARD OF STREET 80632 COMMISSIONERS GREELEY, 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 to. amount of any tax if" placed thereon by any governmental authority and to pay the same on our behalf. E° msj)s a Witn it Owner(s)Signature(s): —'� M. J. Geile, Chair (09/19/01) r__ �� Deputy Clerk o' . Owner(s)S.S.or Tax I.D.# 84-6000-813 v\c4 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. 2001-2737 EXHIBIT"A" CLC GU#2 T2N,R66W SEC.18:SI2 326.38 ACRES,MIL J Sand Formation WELL#610500 -.__.. REVISED 8/16/01 REVISED 1 PRIOR OWNER j DECIMAL DECIMAL INTEREST NUMBER OWNER NAME MAILING ADDRESS INTEREST INTEREST I TYPE 9743 WCR 16 BEA776 DARRELL L.BEARSON AND NELVA M.BEARSON FT.LUPTON,CO 80621 0.00294902 0.00269320 RI 36 STEELE ST.#250 CAN566 CANNON LAND COMPANY _ DENVER,CO 80206 0.07926727 0.07941770 RI 36 STEELE ST.#250 CAN566 CANNON LAND COMPANY DENVER,CO 80206 0.07926727 0.07941760 ORR P.O.BOX 536 6505 E.160TH AVE. DEG261 MARCUS A.DEGENHART [BRIGHTON,CO 80602-6006 0.0.0.033958 0.00033960 ORR j80 SOUTH 27TH AVENUE FAR520 FARMERS RESERVOIR&IRRIGATION CO. 'BRIGHTON,CO 80601 0.00203750 0.00203760 RI J.P.FIELD ESTATE 11414 BANK ST. FIE520 CIO M.F.BOUDREAU,EXECUTOR LAKE CHARLES,LA 70601-6206 0.00013244 0.00013250 RI GROUND WATER MGMT SUBDISTRICT OF THE CENTRAL COLORADO WATER CONSERVANCY 13209 W.28TH ST. GRO853 DISTRICT I GREELEY,CO 80634 0.00035618 NO INTEREST RI '6386 WELD COUNTY RD.23 HEI503 ,RICHARD L.HEIN FORT LUPTON,CO 80621 0.00750391 NO INTEREST RI ,6196 S.CARSON ST. HIL400I BOB HILL ENGLEWOOD,CO 80111 0.00033958 0.00033960 ORR 805 MEADOW RUN HOO852 MATTHEW R.HOOVLER 'GOLDEN,CO 80403 0.00033958 0.00033960 ORR HSR001 HS RESOURCES,INC. I 0.01060727 0.01055960 ORR JUR326 SHANNON JURGENSEN ADDRESS UNKNOWN 0.00207772 0.00207780 RI 129 NORTH 4TH AVENUE JUR327 EILEEN J.JURGENSEN BRIGHTON,CO 80601 0.00831088 0.00831140 RI P.O.BOX 1109 KEN527 KEN PERKINS OIL&GAS INC. INGRAM,TX 78025-1109 'NO INTEREST 0.00210860 ORR P.O.BOX 3248 MCC855 _MCCULLISS RESOURCES COMPANY,INC. LITTLETON,CO 80161-3248 0.00103885 0.00103890 RI BRADY LANDON NELLIS AND CHRISTINE J. 13420 BRAUN RD. j SMITH,JTS GOLDEN,CO 80401 0.00185941 !NO INTEREST RI iROeERTS FAMILY TRUST 2501 E.104TH AVE.,#1201 '. ROB274 INORMA JEAN ROBERTS TTEE DENVER,CO 80233 NO INTEREST'. 0.00371910 ; RI 7311 MONROE SHO770 ILOIS G.SHORT MISSION,TX 78572 0,00415543 0.00415570 I RI 9378 WCR 25 STA350 ROBERT M.STAHL AND MARY E.SHAHL,JTS FT.LUPTON,CO 80621 • 0.00350244 ' 0.00164860 [ RI SUN004 SUN OPERATING LIMITED PARTNERSHIP ADDRESS UNKNOWN 0.00210881 NO INTEREST ORR P.O.BOX 13557 VAU335 GEORGE G.VAUGHT,JR. DENVER,CO 80201-3557 0.00103885 i 0.00103890 RI WAT037 WATTENBERG GAS INV.,LLC 0.78186546 10.78173050 91510TH STREET WEL210 j WELD COUNTY BOARD OF COMMISSIONERS GREELEY,CO 80632 0.00494822 0.00543440 RI CIO PETERSON MGMNTCO INC. (7586 WEST JEWELL AVE.#202 WEL268 WELCO VENTURE !LAKEWOOD,CO 80235-2309 0.00595433 0.01345910 RI I _ ... t TOTAL: 1.00000000 1.00000000 Page 1 HS RESOURCES, INC. 1999 BROADWAY, SUITE 3600 DENVER, COLORADO 80202 (303) 296-3600 FACSIMILE (3O3) 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 anyciie odic:- 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 Hello