HomeMy WebLinkAbout20001587.tiff OIL AND GAS DIVISION ORDER
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OPERATOR: HS RESOURCES, INC. Date: June 21, 2000 11
1999 BROADWAY, SUITE 3600 Effective Date: Date of First Production
DENVER, CO 80202 Well Number: 990350
(303)2964600
Well Name: HSR MILLER FEDERAL#15-6A
Description: T2N, R66W, SEC. 6: S/2
Formation: J SAND
County and State: Weld,Colorado
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 decimai 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 lass 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 royally
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 regardinr_I the interest In
production claimed herein by the undersigned. The undersigned agrees to indemnify and reimburse HS RESOURCES, INC.any amourt 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 ary otter 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 an ount of any tea
placed thereon by any governmental authority and to pay the same on our behalf. {
i es I `kII\ L4,<�, 2))
Owner(s)Signature(s): '- J / N..--
Barbara J. Kirkmeyer, Chair Co• ''d�, 1
(06/28/2000) Deputy Clerk rtlt i p„.xd
Owner(s) S.S.or Tax I.D.# 84-6000-813 C"/-• _'
!i'vLi
Owner Daytime Telephone#_ (970)356-4000 X4200
Owner Fax Telephone# -_ (970)352-0242
PLEASE DO NOT REMOVE EXHIBIT "A" FROM THIS DIVISION ORDER
C Federal Law requires you to furnish your Social Security or Taxpayer Identification Num
Failure to comply will result in 31%tax withholding and will not be refundable by Paycc 2000-1587
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L ' 4r sou,tecs sFC^t'19�
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EXHIBIT "A"
PLEASE DO NOT REMOVE EXHIBIT "A" FROM DIVISION ORDER
HSR-MILLER FEDERAL
#15-6A
T2N, R66W
Sec. 6: S/2
321.48 Acres
J Sand Formation
Well#990350
Mailing Decimal Interest I Interest
Owner Number lOwner Name Address Interest Calculation I Type
12996 25th Street
BRA330 (George Scott Bragg IBoulder, CO 80304-2808 0 01986910 2/3 x 50 MI x .125 RI x 153.30/321.48 acres; RI
HS Resources Inc. 0.00414330! RI
Tr
'HS Resources, Inc. 0.85373160 NRI
HS Resources, Inc. 0.00894110' ORR
--- -- _ _
10952 Hwy 85 �
KUN945 Kunzman Family, LLC Fort Lupton, CO 80621-9602 0.014430701 2/3 MI x .125 RI x 55.67/321.48 acres RI
Franz R. Kunzman and Carmie Kunzman, 1359 E. Ginter
RI R
(Longmont United Hospital Foundation P. O. Box 1159 I
KUN955 joint tenants Tucson,AZ 85706 0.00721530 1/3 MI x .125 RI x 55.67/321.48 acres I
9 Agent 3250 Ocean Park Blvd.-Suite 140 1 =
I 113 x .50 MI x 125 RI x 153.30/321.48 acres RI
LON357 First National Bank of Longmont, Longmont, CO 80502- 59 _ -
MAC345 Machii-Ross Petroleum Company Santa Monica, CA 90405 - - -0.00596070' .025 ORR x .50 x 153.30/321.48 acres! ORR
Magness Land Holdings LLC, a Colorado limited 4000 E. Belleview Ave. f
liability y company Greenwoodi Village, CO 80121 I 0.014901801 .50 x .50 MI x .125 RI x 153.30/321.48 acres; RI
t '12251 WCR221/2 -
MIL531 ;Elton N. Miller and Catherine S. Miller Ft. Lupton, CO 80621 0.03012620 .50 MI x .125 RI x 154.96/321.48 acresi RI
IMinerals Management Service P. O. Box 5810-MS652
MIN275 [Royalty Management Program Denver, CO 80217-5810 0.0094602011 1.00 MI x .125 RI x 24.33/321.48 acres) RI
1357 43rd Ave., Unit#15 - I r
O1O559 Thomas F. and Mildred L. Quinn,joint tenants Greele CO 80634-2444 0 01490180!( RI
y, .50 x .50 MI x .125 RI x 153.30/321.48 acres
1P. O. Box 843169 —
UNI660 Union Pacific Resources Co. Dallas, TX 75284-3169 0.00567610' .075 ORR x 24.33/321.48 acres', ORR
- 915 10th Street
WEL210 Weld County Board of Commissioners [Greeley, CO 80632 0.00070770. 1.00 MI x .125 RI x 1.82/321.4a acres. Ri
1 TOTAL:!, 1.00000000
Page 1
HS RESOURCES, INC.
1999 BROADWAY, SUITE 3600
DENVER, COLORADO 80202
(303) 296-3600
FACSIMILE (303) 296-3601
I
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.
?. 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. "Ihe 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 descrrigtion, and
percentage of coyaitjies, if applicable.
BY: / t�
County Attorney
DATE: — ^
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