HomeMy WebLinkAbout20001880 ' IL AND GAS DIVISION ORDI
OPERATOR : HS RESOURCES , INC . Date : July 27 , 2000
1999 BROADWAY, SUITE 3600 Effective Date : Date of First Production
DENVER , CO 80202 Well Number: 621171
( 303) 296-3600
D
Well Name : WILLIAM DEASON GU #2 OS
Description : T1 N , R66W, SEC . 6 : E/2
Formation : CODELL/NIOBRARA
County and State : Weld , Colorado
Owner: Address : Decimal Interest:
WEL210 WELD COUNTY BOARD OF 915 10TH STREET 0.00394150 RI
COMMISSIONERS GREELEY, CO 80632
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 byHS 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 holHS 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 reimburseHS 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 amou t of any tax placed
thereon by any governmental authority and to pay the same on our behalf. F-64 ,5 -it y ess/ ' ttes :
Owner(s ) Signature(s ) : - ci �. tt. ti 't, / )11L/&t c. �., _ ► ' ;.r .i �,, r,��
C er t t - Bsl ?d ' `(�>
Barbara J . Kirkmeyer ( 0 / 07 / 00 ) .• n
De
puty Clerk to p ' o ' � -i ;
Owners S .S . or Tax I . D. # 84 - 6000 - 813 UN 't
Owner Daytime Telephone # ( 970 ) 356 - 4000 X4200
Owner Fax Telephone # ( 970 ) 352 - 0242
PLEASE DO NOT REMOVE EXHIBIT " A " FROM THIS DIVISION ORDER
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.
2000- 1880
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HS RESOURCES, INC. \/HD COP-TH.
1999 BROADWAY,SUITE 3600
DENVER,COLORADO 80202
(303)296-3600 01 ';^ r 5 ^t 07
FACSIMILE(303)296-3601
1 lECJL_1'l,`D
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 m the space provided exactly as it is shown BEFORE TWO
WITNESSES.
3 -Your SOCIAL SECURITY NUMBER or TAX IDENTIFICATION NUMBER must be
shown m 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
authonzed 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 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 ongmal 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
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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 r ies, if applicabl
BY:
Count A ney
DATE: cz/t-s( ma
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