HomeMy WebLinkAbout20000714 , IL AND GAS DIVISION ORDLA
OPERATOR: HS RESOURCES, INC. Date: MARCH 15, 2000
1999 BROADWAY, SUITE 3600 Effective Date: DATE OF FIRST PRODUCTION
DENVER, CO 80202 Well Number: 990440
(303) 296-3600
Well Names: (HSIRGRANDVIEW ESTATES 11 -19A
Description: T3N R67W, SEC. 19: W/2
Formation: "J" SAND
County and State: WELD COUNTY, COLORADO
fin 05- i a 3 - / R fa i eirandvrew Es ta.Jes ( O1 ) II-1"
Owner: SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF
Decimal Interest: SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF
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 the amount of any tax
placed thereon by any governmental authority and to pay the same on our behalf. vv.Owner(s) Signature(s): iftetQ, ti ► l�i ✓: ✓t
C ,• rk to . - rar . ✓�
Barbara J . Kirkmever , Chair t& - Vii, aP`
1r
Deputy Clerk t : p ',,y} "��
Owner(s) Tax I.D. # 84-6000-813 ( 03 / 22 / 2000) _
, 0f 'r
Owner Daytime Telephone # ( 970) 356-4000 X4200 , (U r
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.
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EXHIBIT "A"
HSR GRANDVIEW
ESTATES 11-19A
T3N R67W, Sec. 19: W/2
320 Acres 1
"J" Sand Formation
Well Number 990440
I Mailing Decimal Interest
Owner Number Owner NameAddress Interest ffL Type
WEB128 (THEODORE WEBBER & 14514 WCR 13 0.034193751 RI
ELIZABETH WEBBER PLATTEVILLE, CO 80651
, -
SEK427 iSEKICH EQUIPMENT COMPANY 4315 HWY 66 0.03859245 RI
LONGMONT, CO 80504
SE K425 _ NICK SEKICH, JR. & KAREN 6790 WCR 32 0.00097913 RI
S. SEKICH PLATTEVILLE CO 80651
SEK422 'FRED M. SEKICH & DONNA L. 1304 GRANDVIEW LANE 0.00127280 RI
SEKICH MEAD, CO 80542
WEL21U WELD COUNTY Y BOARD OF '915 19 T H J l rcrc u O.0007 2 107 RI
COMMISSIONERS --- GREELEY, CO 80632
-i
NIE705 'COLLEEN NIES 5430 E. MANSFIELD AVE. 0.04744360 RI
DENVER, CO 80237
I PAUL D. HOPP &JANICE L. HOPP, 302 GRANDVIEW LANE 0.00020313 L RI
(TRUSTEES OF THE PAUL& JANICE LONGMONT, CO 80504 j
'HOPP LIVING TRUST
LOUIS W. LAWS & MARGARET A. .103 GRANDVIEW DR. 0.00018687 ! RI
LAWS LONGMONT CO 80504
— — C
Page 1
EXHIBIT "A"
'Owner Number Owner Name , Address Interest Type
IMYRON DRAPAL ,108 GRANDVIEW DR. 0.00013352 RI
I LONGMONT, CO 80504
[HERMAN DALE HOLLENBECK& I102 GRANDVIEW DR. 0.00013220 RI
LEVON JUSTINE HOLLENBECK LONGMONT, CO 80504
MICHAEL S KALE & MARY A. KALE 222 GRANDVIEW CIRCLE 0.00010314 RI
LONGMONT, CO 80504
i I
1WILLIAM L. HOAGLAND & PHYLLIS 1104 GRANDVIEW CIRCLE 0.00010477 RI
HOAGLAND LONGMONT, CO 80504
tF
[BRYAN K. & SHERRY WHITAKER 107 GRANDVIEW DR. 0.00020832 RI
LONGMONT, CO 80504
[JEFF & LORRIE R. NISSEN [115 GRANDVIEW DR. 0.00021035 RI
LONGMONT, CO 80504 '
GEORGE M. & DIANNA L.. 112 GRANDVIEW DR. 0.00.0.15121 - RI
BARRETT [LONGMONT, CO 80504
IMURIELLE C. KISSNER & HANS L. 1110 GRANDVIEW DR. 0.00013241 RI
KISSN;ER ILONGMONT CO 80504
[JONATHAN & LORI J. MURRAY 1/204 GRANDVIEW DR. I 0.00010284 RI
- - - - LONGMONT, CO 80504 _ - - -
-- - }
THOMAS R. HOIDA 102 GRAND VIEW CIRCLE 0.00012844 RI
HOIDA SECOND FAMILY LTD LONGMONT, CO 80504
,PARTNERSHIP
INS RESOURCES, INC. 0.87500000 WI
- - --
TOTAL 1.00000000
Page 2
COUNTY ATTORNEY
STAFF APPROVAL
This is to affirm the attached
Division Order or 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: / > . —e— -
�eGnty Attorney
/ f
DATE: /,- i (' i_ -
HS RESOURCES, INC.
1999 BROADWAY, SUITE 3600
DENVER, COLORADO 80202
March 15, 2000 _
(303) 296-3600
FACSIMILE (303) 296-3601
TO: Interest Owners
HSR GRANDVIEW ESTATES 11-19A- "J"Sand Formation
T3N R67W,Sec. 19: W/2
Weld County,CO
Enclosed is a Division Order(in duplicate) for your interest in the captioned well. Please execute it in the following manner:
Be sure that your interest is correct.
Sign your name as it appears typewritten in the space provided in the presence of two witnesses.
If your social security number or tax identification number is not shown, please provide the number and fill out the
enclosed Request for Taxpayer Identification Number and Certification, signing and dating it at the bottom.. Failure to
provide the number may result in a 20% withholding of your production proceeds, as required by law, and you also could be
subject to a penalty imposed by the Internal Revenue Service. IF THE INTEREST IS OWNED BY A TRUST, TRUSTEE,
PARTNERSHIP OR ESTATE,A TAX I.D. #IS REQUIRED,NOT A SOCIAL SECURITY NUMBER.
Please fill in your daytime phone number and fax number if any.
Verify that your mailing address is correct If it is iu.urrect, please note your correct address.
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.
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.
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.
If you see a name on Exhibit "A" with "Address Unknown" in the address portion and happen to know the address or
phone number of that owner, please advise us.
Should you have any questions, please do not hesitate to call.
Very truly yours,
HS RESOURCES,INC.
Susan Howard
Sr. Division Order Analyst
ish c'onsenf A te..
Ends.
a3/aa/aaYD
4.60072
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