HomeMy WebLinkAbout20013117.tiff IL AND GAS DIVISION ORD
OPERATOR: HS RESOURCES, INC. Date: October 19,2001
1999 BROADWAY,SUITE 3600
DENVER,CO 80202 Well Number: 614310, 614311
(303)296-3600 617100, 617101
Well Name: CAMP 13-19
PLATTEVILLE 23-19
Description: TOWNSHIP 3 NORTH,RANGE 66 WEST
SECTION 19: W/2
Formation: CODELL/NIOBRARA/J SAND
County and State: WELD COUNTY,COLORADO
Owner: Decimal Interest: Type:
Weld County Colorado WEL225 0.00241800 RI
c/o Board of Cnty Commis.
P O Box 758
Greeley CO 806320758
The undersigned certifies the ownership of the decimal interest in production or proceeds as described above payable by HS RESOURCES,INC.
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 herein _y tax
placed thereon by any governmental authority and to pay the same on our behalf. (E /4„/
Wit yIttO
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Owner(s)Signature(s): fl(,(,(� 'O -
We d o my olorado, M. J. Celle a t'
Address: 915 10th Street
Deputy Clerk to the oard.- -'`` •
Greeley. CO 80631 it
Owner(s)Tax ID#/ 84-6000-813
Social Security Number 84-6000813
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.
2001-3117
HS RESOURCES, INC.
1999 Broadway, #3600
Denver, CO 80202
303-296-3600
303-296-3601 (Fax)
October 22, 2001
TO ALL INTEREST OWNERS:
RE: CAMP 13-19
PLATTEVILLE 23-19
Township 3 North, Range 66 West
Section 19: W/2
HS Resources, Inc. recently recompleted the referenced wells in the J Sand Formation.
We have updated our records to reflect your ownership in this formation and enclose new
Division Orders to verify your interest.
Please review the Division Orders and if they meet with your approval, execute the
Division Orders, have your signature witnessed by two individuals, include your social
security number/tax id number if needed and return the original to our office. The
Division Order marked "COPY" is for your records.
Please note that if you sold this property and did not reserve the minerals we will need a
copy of the recorded Deed conveying these lands to a new owner in order to update our
records. Thank you for your prompt attention to this matter. Please contact our office if
you have any questions.
Sincerely
HS RESOURC S,IN .
ini ct L, -. - 1-e,'.;/-(-(
MARY . HALSEY l
Division Order Supervisor
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Enclosures
L/ cid7
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 applji ble.
BY: / 1
19( 1 1
County Attorney
DATE:
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