HomeMy WebLinkAbout20002252 YOUR COPY
OIL AND GAS DIVISION ORDER
OPERATOR: HS RESOURCES, INC. Date: September 14, 2000
1999 BROADWAY, SUITE 3600 Effective Date: Date of First Production
DENVER,CO 80202 Well Number 100050
(303)296-3600
Well Name: HSR AMELIA ELIZABETH 4-5
Description: TIN, R66W, SEC. 5: N12
Formation: J SAND
County and State: Weld,Colorado
Owner: Address: Decimal Interest:
WEL210 Weld County Board of 915 10th Street 0.00098920 RI
Commissioners Greeley, CO 80632
The undersigned certifies the ownership of tire decimal interest in production or proceeds as descrioed 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 ove payment
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 sur h claim o
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 change s 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 'roduction
claimed herein by the undersigned. The undersigned agrees to indemnify and reimburse HS RESOURCES, INC.any amount attributable to an interes• 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 I ,quired by
applicable state statute.
This Division Order does not amend any lease or operating agreement between toe undersigned and the lessee or operator or any other contra,is 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 aws 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 the amount of any i ax placed
thereon by any governmental authority and to pay the same on ouraehalf. W
^ /,, n ��� ��YOY�1l�sst 1:1r, .�'_ . 6,,)
Owner(s)Signature(s)• ZZt4414-- _ -__-4. 2(1,7'
(09/2 00) t ct
Barbara J. Kirkmeyer, Chair Clerk to the Boa Q __
Owner(s)S.S.or Tax I.D.# 84-6000-813_ _ By: . - r Deputy Clerk to `k
Owner Daytime Telephone#J970)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.
•:-.;(i71- . -? .z.../..7%;
/ S . C C
EXHIBIT"A"
HSR-AMELIA ELIZABETH 46
._-
TIN,MOW,SEC.5:
WELD COUNTY,
COUNTNT Y,,CO JEL FORMATION
WELL*100100060.
•
1' DECIMAL INTEREST
OWNER 0 OWNER NAME 1 MAILING ADDRESS INTEREST TYPE
---- 153]-36 Court
HUM637 Hugh E.and Lorena C.Humphreys 'Greeley,CO 80634 0.00012710 RI
Edward lacino 6211 E.42nd Ave.
140456 C/o Seattle Fish Company Denver,co 80216-4615 '0.00016690 RI
D.Rointenaand Margie M.Imhoff Ft. o Cl
IMN630 nb 70 Lupton,rd9.0.CO 00821-1040 1.O.o0039400.I RI
- Independent Order Odd Fellows 709Jd Sri.
IND261 ,Lupton Lodge 1100 1 pllon,CO 606211806 0.000119]011 RI
707 Harrison
- _- - - 707Ave. 1
JA5603 Guellermo Jaso Fort LpX ,CO 806211718 0.000166701 RI 10432 JOH608 'Eldred M.Johnson 'GrassiYisIYn a 909494744 0.00004770 RI Hson,60
KEL534 :John Kellerman .Fort Lupton,CO 80611-1714 0.000043401 RI
1050 Tranquil Ln.
KLO021 'Ervin Eugene Klovdahl Estes Park,CO 60511-]513 0.00010]30 RI
- '138 Pacific Ave.
KRA51J !Robed J.and Joann L.Kramer 'Fort Lupton,CO 00821-172D 10-00011910, RI
P.0.Boo 466
LAF665 Bill and Mary A Lefton Hudson,CO 00642-0466 0.00009140' RI
James D Lambert 155 Bridge St.
LAMIJD and Barbara Jean Bookman Brighton,CO 80.001-1612 000010730'1 RI
4645 Wy ndol
LEO3]5 Daniel Letlesma 'Denver,CO 80111-12112 .0.00000190. RI
Thornton,COWashington022No.70
LED3)0 Henry Letlesma 6810 Do In 802396865 0.00000190 RI
6810 Downing
I
LE9 !James Letlesma 'Denver,CO 80229-]108 .
DZI 0.00000190 RI
• __. . P.O.Boa 212
LEL804 Joseph I.Loll Foil Lupton,CO 80621-0112 0.00016490 RI
Joseph I.and Freida F.Lell P.O.Boa 322
Lewis „1ngmoN,OCO 805049497 '0_0000800, RI...
LEL505 Joint T is _ Forth 1 CO 80621-022] 0.00008344.
7
LEW400 1Chade D. d V tree A. RI
th St.
LEVV482 IJoe J.and Marie Lewis
LOP396 T!Hilda and Ram L.Ybarra Lopez �fHend1140 S Lupton.8301 no ,PCO 50640-09115 04th Way 1110_00009540 RI
0.00009540 RI ul t.
LOP290 'Rita Lopez Denver.CO 602084345 10.000230401 RI
504 Pacific Ave.
LUJ150 Roy and Grace Lulan Fort Lupton,CO 80621-1]14 0.00025430' RI
i 7500 Kearney St.
LUN105 Nellie C.Luna Commerce City.CO 00023-1116 0.00008340 RI
1130 Denver Ave.
LUP765 Lupton Lodge 119 AF and AM Fort Lupton,CO 80621.1016 0.00027410 RI
'19 Founlain Ct.
MAL6W Craig Allan and Sheila J.Malone Wilmington,DE 19000-3011 0.00009930 RI
Manna Pro Corporation 707 Spirit 40 Park Dr.,Suite 150
MAN516 Attn.:John Mrnard Chesterfield,MO 63005 0.00076660 RI
43O Harrison St.
MAR774 Mike R.Martinez St.Louis,MO 00821-1711 0.00012710 RI
6521 Clay Street,837
MED451 Martin and Julia Medina Denver,CO 00221.2336 10.00008340' RI
i _ Harrison _..
'F0rtH Ave.
A Mee Lupton,CO 80621 0.000107301 RI
903 Harrison Ave.
MEZ104 1Jmes V.M Fort Lupton,CO 80621-1719 0.00005560 RI
Minerals Management Service P O.Box 5810445652
MIN275 Royalty Management Program Denver,CO 00217-5810 '0.00889906 RI
• 1484th St.
MON772 'Jennie 0.Montoya Fort Lupton,CO 60621-2014 10.00013 32 0 1 RI
.3233rd St. I
MONI76 Sal and Stella Montoya iFort Lupton,CO 808211909 '0.0002106011 RI.
312 Central Ave.,Box 210
MOR10J Raymond L.Mora Platteville,Harrison CO 80651 0.00008]401 RI
439 Hare Ave.
MOR163 Angel and Annabelle Morales ;Fort lOM1 CO 80621.1710 10.00006]50 RI
291 Kahil u rt.
l.
MU5205 Lennie C.Donald
Rosemary E.Muse Foil St. CO BO6P-1221 000011640 RI
Glenn M Ie Neely and [Foil
4u5t.
643352] Joyce Malone Neely _ 220 Lupton,CO 60621-1011 1000011]10' RI
Fo Fort
Main
NEL)03 Harvey G.and Amelia Nelson 1906 S.McKinley
coryCO 80621-1030 10.00006160 RI
For 9.Lupton.
COAve.
NIE]6] 1Ma0te Nieronlr 838 C 80621-1163 0.00009540 RI
_-- - ]J6 Pacific Ave.
NOL1]2 ;IBenjamin and Frances Nalasco Fort Lupton,CO 808211726 0.00003980, RI
229 Harrison Ave. 1-
NOR356 Norman and Arlene M.Norneet _ FortLupIon,CO 80621-1]06 '0.000214501 RI
_... Quebec Den[Denver,
CO 802
NUN190 .Louise a Louis Nunez - j 72 HarrisonCo eox07<070 0.0oolmo0 RI
-- - -- - 722 Ha
NUN39J Martin and Maria Nunez Ft.Lupton,CO 60 6 21-1717 .0.00006]60 RI
- 10253ni St.
OLI817 'Leroy and Patricia Olives Fort Lupton,CO 60621.1743 10.00013510 RI
1501 East 102d Ave.Apt.A-105
OZA015 Lydia Ozawald !Thornton,CO 00229-2024 0.00000190 RI
Helen M.Parker Colorado Trust c/o Kennedy A Coe,LLC
Robin A.Parker and Jan Palter, 1901 06th Ave.
PAR428 Co-Trustees Greeley,CO 80634 0.02182016 RI
1111 3r,1 St.
PENJ65 Donald K.Pentoltl Fon Lupton.CO 80621-1]41 0.00000340 RI
7016 Hazelnut Dr.
PERIOD Ernest Perez Newark,CA 94560-2236 0.00001140 RI
727 Harrison Ave.
PER202 Marie Perez Fon Lupton,CO 00611-1716 0.00008340 R.
7816 Hazelnut Dr.
PER293 •Ramon Perez Newark,CA 94560-2236 •000004570 RI
Fa Pacific Ave.
PRIM Nellie P.Price ,Fad LuMpton,CO 80d31-1713 .0000254]0 RI
1 Lon mint,C 8 Rd.
PUT512 Juanita M.Putnam 129 P91k Ave. 80604.621] 0.00010730 RI
329P Park Ave.
RAM473 '.Jesus V.and Irene D.Ramirez Fort Lupton,CO 606211929 _ 1000016280 RI
- - 64964 son Ave.
RAN325 Victor G.and Lucy Range: f rtLupton,CO 00621-1712 1'0.00016260 RI
x.616 Pacific Ave.
REO245 John Redding Fort Lupton,CO 00621.1]25 0.00009140 RI
619 Harrison Ave.
REY211 Atiland and Elsie Reyes Fort Lupton,CO 60021.1]'4 1000008340 RI
8 318 S. th 1
REY375 Louis and Loge Reyes Brighton,OO 006013110 ,.0.00004770 RI
P.O.Boo III
REY276 Louis G.and Susie B.Reyes 'Brighton.CO 80601-0111 0.00013110 RI
115 Hanson Ave.
RIC354 Edwin L.died Charity R.Richmond Fon Lupton,CO 80621-1704 10.000250]0 RI
Page 2
EXHIBIT"A"
HSR-AMELIA ELIZABETH Oaf
- - - - TIN,P00W SEC.6:N12
WELD COUNTY,CO
J SAND FORMATION
WELL II 100060 _
- _ _1. _ - 1-DECIMAL INTEREST
OWNER 9 OWNER NAME MAILING ADDRESS • INTEREST TYPE
436 Pacific Ave.
RIV263 Joe.V.and Ruben Rivera 'Fort Lupton,CO 80621-1723 0.000011401 RI
- - P.O.Bon 373
RW366 Margaret Rivera 'FortLupton,CO 80631-0]1S 0.00001140, RI
• P.O.Boy 9
ROJ604 James L.and Sandra J.Rojo Fort Lupton,CO 00621-0009 0.000111201 RI
Jack L.Ryan Henryand GorgeNn 163 McKinley Ave_
RYA50J IBreickler Fon Lupton,CO 80621-1941 0.0002622011 RI
.163 McKinleyAve.
RYA504 Mary E.Ryan i Fort Lupton,St. ,d CO 80621-1941 0,00016890 RI
- - fiU]lld St.
SAL201 John M.and Rebecca M.Salazar Fort Lupton,CO 00621-1800 10.00012710 RI
-_. 330 8th Bt.
SAN2J0 Genero Sanchez Fort Lupton,CO 80621-2120 I 0.00009140. RI
Arthur Sandoval and Esther 722 Paretic Ave.
SAN2T2 Louise Zalvala Fort Lupton,CO 00621-1726 :0.00007550, RI
-- 3656 Depew Street
SAU522 l Elizabeth 0.Saunders Denver,CO 60212-7049 0.00017430 RI
- - 806 DenverAve.
SCH531 Bernard i.and Theresa C.5Tmanski FortLpton,CO 806212164 10.00022660 RI
15750 W.20th St.,111
5EA770 J.Lee Sears (Greeley,CO 00634-2942 0.00016680, RI
51M676 Willie L and Jo Ann Simpson Brighton,CO 80601-1711
!601.1711 0.00004770' RI
642 enison SOT602 Eulemio and Alice Soto Fort Lupton CO 80621-1715 -0.00022440! RI
Southey Weld Improvement Assn .Ben Franklin Store
9
SOU226 ,UO Andy Lake 100 Wp1oryC080o. 0.00020210 RI
104 York,lStreet 4.4B
STE352 (Jana Rae Steele New 4027-0 Rucker
Ave.,100144361-370 10.002]196] RI
Ever-0 Ruck.r 21.,9308
STE25J -PMDtla Steele Everttl,WA 982016035 10.0023196]! RI
- 2704 NE 69th St. 1
STE264 Russell E.Steele Seattle WA 1101154456 10.00231953, RI
-703793 S.Seventh Ave.
511754 John Stirling 'B ghl ,CO 80601-3216 0.00012710! RI
1910 Sparta Dr.
SWE252 Howard B.Sweeney Lafayette,CO 00026-1173 10.00051650,9]45,Denver Ave. RI
THI276 'Ronald Thiesen ii Fort Lupton,CO 80621-0240 0.00007550! RI
Lester and Sandra Thorn Jr. 'P 080616332
TH0505 Joint Tenants Denver,CO 80216-0332 10.00033770 RI
Fog Harrison
THOSJ0 Lela F.Thomason 1FortLupton,CO 806217208 10.00025820 RI
TORT28 Rudolph A and Cecilia Torres I ADDRESS UNKNOWN j0.00013110 RI
F]2 Denver Lupton,St.
iR116J ',Triangle Motor Company - Fon Lapton,lSry CO 80621-1622 0.000011344 RI
639 Main u St.
TYEH6 Jesus L.TYerina IFo0lBMO 4116 80621-2160 !0.00006560 RI
-- ,P.O.Box 043169
UNI663 Union Far Inci Resources Co. Dallas,T% 76204-3169 ''.0.00177981', ORR
- 120 Harrison Ave.
UYE58T George H.Uyemura _ Fort Lupton,CO 60621-1705 0.00040620 RI
Lulla V.Vaughn 906 S.McKinley Ave.
VAUJ38 clo Mrs.John Honstein Ft.Lupton,CO 80621-1203 1000012710 RI
]257 Dahlia St.
V1N224 katharm L.Vincent Denver,CO 80207-3752 0.01547006 RI
lay S.Denver Ave.
VIN2J5 Vincent Properties Inc. Furt Lupton,CO 80621.1306 0.01547006 RI
6161 E.64th PI. '
WAG6J2 Herman and Dora Wagner Commerce City,00800222701 11.00012710 RI
Herman Wagner and Dora Wagner 6161 E.64th PI. 1
WAG533 and Ruben Wagner !Commerce City,CO /0022-2701 0.00012710 RI
15468 Lamb Ave.
WAR196 Esther Eloise Ware Fort Lupton.CO 806214233 0.00012710 RI
.. .___._ . .
- - 16300 Yosemite Street
WAT445 -Billy J.Watkins Brighton,CO 80601 1000006]60 RI
- 9112 Meade SL
WEA732 Jerry J.and Linda M.Weatherman Westminster,CO 90030411] 0.00010730' RI
_. ._.. --e
-- -- 19161%h Street
WEL210 :Ward County Board of Commissioners 'Greeley,CO 80632 0.00099920 RI
- - 10966 Menet Way
YOU544 Ruby Young _ 14 Palean,cinryCO 80234-3315 ",0.00000190 RI
- :42020 Lupton,
u Pacific
ZARt36 Eulallo ZaraOoza !Fort L CO 80621-17230.00007660 RI
TOrAL:I1.00000000
Page 3
HS RESOURCES, INC.
1999 BROADWAY, SLITE 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 Fonn 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 niusi 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 He 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,yeyaltie§, if appli'e`able.
C- 2
BY:
County Attorney
a
DATE: % ��
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