HomeMy WebLinkAbout992520.tiff chiq OIL AND GAS DIVISION ORDER DT
Date: September 29, 1999
Lease No.: 113263022
Lease Name: Glens VV 6-14 (J)
Effective Date: First Sales
To: Patina Oil & Gas Corporation
1625 Broadway, Suite 2000
Denver, CO 80202
Each of the undersigned, individually, for themselves, their heirs, successors, and assigns, hereby
represents, warrants, and guarantees to Patina Oil & Gas Corporation (hereinafter referred to as the
"Company"), its successors and assigns, that the undersigned is the legal owner of the decimal interest, as set
forth below opposite each undersigned's name, in the proceeds from all oil, condensates, and natural gas
which may be produced from or allocated to the following-described area or well located in the County of
Weld, State of Colorado, and more particularly described as follows:
Township 1 North, Range 67 West, 6`h P.M.
Section 6: W/2
Commencing on the effective date hereof, the Company is hereby granted and authorized to take and
receive all oil, condensates, and natural gas which may be thereafter produced from the above-described area
or well and, subject to the other terms and conditions hereof, to give credit therefor to the undersigned in
accordance with the division of interest schedule asfollows:
Credit To Address Decimal Interest
See Exhibit "A" attached
Additionally, in consideration of the wells drilled or to be drilled on the above-described lands and the
payment to the undersigned of royalties on production from said wells, the undersigned agree, grant, and
represent to and with the Company as follows:
1. Oil (including crude oil and condensate) shall become the property of the purchaser thereof
upon its delivery to the purchaser or to the purchaser's agent or carrier, and payments hereunder shall be based
upon the net price received therefor from the purchaser. Oil shall be graded and measured in accordance with
applicable rules, regulations, or standards generally accepted in the industry. In.the,event that the Company is
the purchaser of such oil, settlements therefor shall be based upon the Company's posted price for similar oil in
the field where produced and in effect on the date of delivery, or if no posted price is then in effect,
settlements shall be based upon the then prevailing market price on the date of delivery thereof in the field
where produced. If the oil is purchased by the Company and resold to another pyviaser, ccepting delivery
thereof on the premises, settlements hereunder shall be based on the net pride 'Valved xherefor•1a' the
Company. The Company may deduct from any price received for the oil the reasonable costs of transporting
and/or treating the same if incurred.
2. Natural gas, including casinghead gas if marketed with gas vyell gas; shall be delivered and
sold to and become the property of the pipeline company to whom the gas-is agreed to be sold by the
Company. Settlements to the undersigned shall be based upon the terms, conditions, and prices for said gas
as agreed to with the pipeline company less any costs of treatment, compression, transmission, or dehydration
thereof which are paid by the Company.
3. Oil and natural gas produced and sold from the premises is or may become subject to orders
of certain regulatory authorities who could vary the terms of any agreement for the production or sale thereof.
To the extent that such orders do modify or change current sales or production arrangements, the provisions
thereof, as well as the provisions hereof, shall be so modified accordingly.
4. Settlements hereunder for oil and gas shall be made monthly by the Company mailing or
delivering their check to the undersigned at the address indicated in an amount, less taxes required to be
withheld, calculated in accordance with the schedule of interest as herein contained. Settlements shall be
mailed no later than the 25th day of each month for oil and/or gas taken or sold during the second preceding
calendar month. If at any settlement date the amount payable to any of the undersigned shall be less than
Twenty-five Dollars ($25), the Company may defer such payment and make payment when such settlement
amount has accumulated to Twenty-five Dollars ($25) but, in any event, not less than annual intervals.
5. The undersigned individually warrant that they are the owner of their respective interest as
herein set forth and that in the event of an adverse claim made thereto or in the event ownership of the
undersigned's interest is not substantiated by record examination, the Company may retain any and all
settlements due therefor, without interest, until such claim or ownership of the interest is settled, fully
adjudicated or otherwise determined, or until the Company is adequately indemnified therefor by the parties
claiming such interest. The Company may, at any time, require the undersigned to furnish proof of its title to
its interest, including abstracts of title or other pertinent records or documents.
992520
6. The undersigned shall notify the Company of any change in the ownership of their interest,
and the Company shall not be liable for, nor shall it be required to recognize, any change in ownership unless
and until the Company shall actually receive a certified copy of the instrument changing such interest and the
transferee thereof executes and returns to the Company such transfer order or amended division order as the
Company may reasonably require. In no event shall the Company be required to give effect to any change of
interest of the undersigned prior to the first day of the calendar month next following the month in which the
Company is notified of such change, regardless of the effective date of the instrument transferring the same.
7. The undersigned hereby represent, grant to, and agree with the Company that the interest of
the undersigned and of the Company in and to the oil and gas which has or which may be produced from the
premises is in full force and effect and that all payments required to be made and all acts required to be done
by the Company with 'espect thereto have been performed. The undersigned hereby releases the Company
from any and all claims; and damages arising from the purchase and handling of oil or gas from the premises
and for making any payments for settlements so long as the same are made in accordance with the terms of
the division of interest schedule set forth on Exhibit "A".
8. In the event that the area or well described above, or any part thereof, is included in one or
more pooled or unitized units now or hereafter formed by order of any appropriate governmental authority by
agreement or otherwise, the undersigned and the Company recognize and agree that settlement for oil and gas
shall be made in accordance with the production allocated to the premises above described without the
necessity for the execution of additional or supplemental division orders. To the extent that the premises as
described above constitute a previously pooled or unitized area, the same is hereby ratified.
9. The provisions hereof shall be binding upon and inure to the benefit of the Company and the
undersigned, their respective heirs, successors, administrators, and assigns. No change in the ownership of
any interest herein described shall have the effect of changing the binding nature hereof. This instrument may
be executed in counterparts with each counterpart considered to be a binding agreement of the signatories
thereto; and all counterparts, as executed, shall be considered to be one instrument.
10. Should it be determined from time to time by the courts, any governmental agency having
jurisdiction, or the Company and the purchaser of production, that the prices or allowances, if any, being paid
to the Company and the amounts being disbursed to the undersigned are in excess of lawful prices or prices
agreed to with the oil or gas purchaser, and a refund is then required, you agree to promptly refund such
excess amounts so paid to you, including interest thereon, if required. Additionally, the Company shall have
the right to recover such excess amounts out of future settlements hereunder to which you are entitled.
WHEREFORE, the undersigned have executed this Division Order in acknowledgment and consent to
the foregoing terms, warranties, and agreements.
Witness
Sign Below: Owner Sign Below: SS No. or Tax ID No.
Weld County Board
of Commissioners 84-6000-813
Attest• ) 915 10th Street
r � Creelely, CO 80631
By. Deputy Clerk * Dale K. Hall, Chair
to Board
IMPORTANT: TO AVOID DELAY IN PAYMENT, YOUR CURRENT ADDRESS AND SOCIAL SECURITY
NUMBER OR TAX ACCOUNT NUMBER MUST BE SHOWN
EXHIBIT 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name & Address . OWNER NO . INTEREST.. . TYPE .. . CODE
PATINA OIL & GAS CORPORATION 20 0.06032320 RI X
1625 BROADWAY, SUITE 2000 0.06032320
DENVER, CO 80202
PATINA OIL & GAS CORPORATION 20 0.82138850 WI X
1625 BROADWAY, SUITE 2000 0.82138850
DENVER, CO 80202
DELETED INTEREST OWNER 99999 0.00000000 WI X
0.02096060
TERRY L. MARTINEZ & 297924 0.00006640 RI SD
SHIRLEY MARTINEZ 0.00006640
P 0 BOX 84
DACONO, CO 80514
ROCKY MOUNTAIN FUEL CO. 301109 0.00010680 RI M
756 INSURANCE EXCHANGE BLDG. 0.00010680
910 15TH STREET
DENVER, CO 80202
SHARON BURY 301157 0.00019930 RI M
BOX 122 0.00019930
DACONA, CO 80514
CYRIL J ENTIHAR 700188 0.00006640 RI SD
P 0 BOX 135 0.00006640
DACOCO, CO 80514
GEORGE HILTON 700221 0.00013290 RI SD
P 0 BOX 265 0.00013290
DACONO, CO 80514
SECRETARY OF H U D 700261 0.00013290 RI SD
1405 CURTIS ST 0.00013290
DENVER, CO 80202
WESLEY BRUCE & REBECCA BAKER 700312 0.00006640 RI SC
11030 BROWNSTONE DR 0.00006640
PARKER, CO 80134
JOHN R & ROSE SEDILLO J/T 700317 0.00009960 RI SA
P 0 BOX 51 0.00009960
DACONO, CO 80514
JOHN P & DEBRA A HALL 700374 0.00019930 RI SA
P 0 BOX 6 0.00019930
DACONO, CO 80514
HARRY & EUGENE BALLINGER 700457 0.00013290 RI SC
0.00013290
NORMA VONFELDT 700501 0.00006640 RI M
BEVERLY LOGROS, J/T 0.00006640
11221 BILLINGS
LAFAYETTE, CO 80026
RONALD HINKLE 700526 0.00019930 RI M
EILEEN HINKLE TEN IN COMMON 0.00019930
308 5TH STREET
DACONO, CO 80514
JOSEPH W & CYNTHIA A KOSS 700553 0.00013290 RI SD
3060 BRIDGE ST 0.00013290
SUITE 392
BRIGHTON, CO 80601
PRIMERA IGLESIA BAUTISTA 700574 0.00003320 RI SD
INDEPENDIENTE, C/O PASTOR 0.00003320
EXHIBIT 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name & Address . OWNER NO . INTEREST.. . TYPE .. . CODE
717 DAHLIA ST
DACONO, CO 80514
MARK H VOSACEK 700597 0.00013290 RI SA
LORA ANN, ROBERT H VOSACEK 0.00013290
P 0 BOX 235
DACONO, CO 80514
JEFFREY A & MARY LYNN BOND 700609 0.00013290 RI M
P 0 BOX 315 0.00013290
DACONO, CO 80514
GERALD E CONOVER 700812 0.00016600 RI M
P 0 BOX 223 0.00016600
DACONO, CO 80514
DARRYL LYNN & CHERYL ANN WOLF 700834 0.00013290 RI SC
0.00013290
KERRY & MARGUERITE JARVIS 700863 0.00006650 RI SD
P 0 BOX 225 0.00006650
DACONO, CO 80514
BURNADEAN L EUBANKS 700974 0.00009960 RI SD
P 0 BOX 71 0.00009960
DACOCO, CO 80514
LELA CONWAY 701067 0.00006640 RI SD
PAUL, JOE & JAMES WAREMBOURG 0.00006640
P 0 BOX 97
DACONO, CO 80514
HAROLD W & SHIRLEY M MULLINS 701120 0.00006640 RI M
P 0 BOX 102 0.00006640
DACONO, CO 80514
RONALD & LINDA ADDISON 701251 0.00006650 RI M
P 0 BOX 205 0.00006650
DACONO, CO 80514
WILLIAM A CORAGGIO 701629 0.00006640 RI M
PATRICIA A CORAGGIO J/T 0.00006640
20576 STAGHORN CT
JOHNSTOWN, CO 80534
JEANETTE CORDOVA 701676 0.00006650 RI SD
P 0 BOX 331 0.00006650
DACONO, CO 80514
LAMBERT & LOUISE D NANE2. 701731 0.00007300 RI SD
711 CHERRY ST 0.00007300
DACONO, CO 80514
EMILIANO & MARIA RUSCITTI 701836 0.00009970 RI M
P 0 BOX 203 0.00009970
FREDERICK, CO 80530
GENE W & DOROTHY L RAY 701881 0.00006640 RI SA
P 0 BOX 173 0.00006640
DACONO, CO 80514
GLORIA IRENE JOHNSTON 702076 0.00013290 RI M
P 0 BOX 36 0.00013290
DACONO, CO 80514
DOROTHY COUZIN ESTATE 702128 0.00006640 RI SD
NANCY STING, HELEN SUSURAS T/C 0.00006640
9990 MELODY DR
NORTHGLEN, CO 80221
EXHIBIT 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name & Address . OWNER NO . INTEREST.. . TYPE .. . CODE
DARRELL & CATHERINE HARTIGAN 702208 0.00006640 RI SU
614 COLORADO BLVD 0.00006640
BOX 193
DACONO, CO 80514
BRIAN W HARTMAN 702319 0.00006640 RI SC
5916 WCR 18 0.00006640
LONGMONT, CO 80501
EDWARD COWAN 702360 0.00019930 RI SU
VIRGINIA COWAN J/T 0.00019930
P 0 BOX 155
DACONO, CO 80514
JOHN & SHIRLEY STELL J/T 702388 0.00006640 RI M
880 BUNYAN AVE 0.00006640
BERTHOUD, CO 80513
BRUCE D REED 702393 0.00019940 RI SC
JAMES GALLOWAY 0.00019940
1850 SOUTHERN
BRIGHTON, CO 80601
CECELIA SABADOS ESTATE 702409 0.00006640 RI SD
C/O HELEN KUHN ADMINISTRATOR 0.00006640
BOX 121
DACONO, CO 80514
ADAM & MARIE HONSTEIN J/T 702506 0.00006640 RI M
P 0 BOX 64 0.00006640
DACONO, CO 80514
JOAN B REEP 702512 0.00501400 OR M
2653 SPRUCE ST 0.00501400
BOULDER, CO 80302
PAUL S REEP 702560 0.00501400 OR M
P. O. BOX 20666 0.00501400
SEDONA, AZ 86341-0666
JULISON MICHAEL W 702568 0.00006640 RI SC
214 6TH ST 0.00006640
P 0 BOX 348
DACONO, CO 80514
ARMAND DUFOUR 702717 0.00009960 RI M
ESTHER DUFOUR J/T 0.00009960
P 0 BOX 96
DACONO, CO 80514
ANTHONY L SHREDNIK 702790 0.00694830 RI M
6782 E ITHACA PL 0.00694830
DENVER, CO 80237
JOSEPH J & SHIRLEY C MAJOR 702873 0.00005980 RI M
5644 S JAMAICA WAY 0.00005980
ENGLEWOOD, CO 80111
BRIAN MARK & SUE ANN MERCER 703042 0.00006640 RI SA
0.00006640
LYNETTE BROOKS 703090 0.00006640 RI SC
P 0 BOX 308 0.00006640
DACONO, CO 80514
KEMP & DOROTHY REID 703166 0.00006640 RI SC
220 5TH ST 0.00006640
DACONO, CO 80514
WILLIAM A NEWCOMB 703252 0.00013290 RI SC
EXHIBIT 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name 8 Address OWNER NO . INTEREST.. . TYPE .. . CODE
20242 MATTERHORN DR 0.00013290
HIDDEN VALLEY LAKE
LAWRENCEBURG, IN 47025
CLARENCE E MESSINGER 703292 0.00013290 RI SA
0.00013290
SAMUEL G 8 GENEVIEVE SANCHEZ 703309 0.00003320 RI M
717 DAHLIA ST 0.00003320
P 0 BOX 174
DACONO, CO 80514
JACK W & LEAH P FINLEY 703412 0.00009960 RI M
204 ASH ST 0.00009960
DACONO, CO 80514
PRYOR BELL 703565 0.00006640 RI SD
JOSEPHINE BELL J/T 0.00006640
P 0 BOX 123
DACONO, CO 80514
WYATT B & MARGARET E CHANDLER 703606 0.00006640 RI M
4220 GREEN CT 0.00006640
DENVER, CO 80211
BENNY CHAVEZ 703812 0.00019930 RI M
ELEANOR CHAVEZ, J/T 0.00019930
P 0 BOX 165
DACONO, CO 80514
JAMES PETROFF 703853 0.00013290 RI M
3136 SPINNAKER DR 0.00013290
LONGMONT, CO 80503
JAKE & SARAH CHAVEZ 703875 0.00013290 RI SC
C/O LARRY CHAVEZ, TRUSTEE 0.00013290
P 0 BOX 63
DACONO, CO 80514
EDWARD A CHAVEZ 703950 0.00013290 RI M
P 0 BOX 93 0.00013290
DACONO, CO 80514
LEONARD FLAKE 704081 0.00006640 RI M
P 0 BOX 2 0.00006640
DACONO, CO 80514
UNION PACIFIC RESOURCES CO 704159 0.01160320 RI M
P 0 BOX 843169 0.01160320
DALLAS, TX 75284-3169
TOWN OF DACONO 704174 0.01465830 RI SD
A MUNICIPAL CORPORATION 0.00000000
P 0 BOX 186
DACONO, CO 80514
FOSTER DYCHE 704196 0.00009970 RI SD
P 0 BOX 218 0.00009970
418 8TH ST
DACONO, CO 80514
DONNA J RICHARDSON 704463 0.00006640 RI M
123 4TH ST 0.00006640
DACONO, CO 80514
FRED 8 CHRISTINE SCHAFER J/T 704481 0.00006640 RI M
213 6TH AVE 0.00006640
BOX 164
DACONO, CO 80514
EXHIBIT 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name & Address . OWNER NO . INTEREST.. . TYPE .. . CODE
HAROLD F SUBBERT 704516 0.00006640 RI M
BOX 13 0.00006640
LUCAN, MN 56255
CATHERINE M VALIN 704606 0.00013290 RI SA
P 0 BOX 86 0.00013290
DACONO, CO 80514
FRANCIS E MARTIN 704659 0.00007120 RI M
P 0 BOX 13 0.00007120
DACONO, CO 80514
GAYLORD DAUM 704701 0.00009960 RI M
MARY DAUM J/T 0.00009960
P 0 BOX 94
DACONO, CO 80514
JAMES & PATRICIA MARTIN J/T 704726 0.00013290 RI SD
305 4TH ST 0.00013290
P 0 BOX 157
DACONO, CO 80514
RONALD D & KIMBERLY J MILLER 704806 0.00013290 RI SD
341 4TH ST 0.00013290
DACONO, CO 80514
KATHERINE & MARION VAN METRE 704816 0.00006640 RI M
P 0 BOX 57 0.00006640
DACONO, CO 80514
MONTIE NORRIS 704882 0.00006640 RI M
1124 MAC DAVIDSON CIR 0.00006640
DACONO, CO 80514
GUS JR & MYRNA A MIRCOS 704930 0.00013290 RI M
P 0 BOX 14 0.00013290
DACONO, CO 80514
SHARON LEE WHITE 705022 0.00006640 RI M
EILEEN A HINKLE 0.00006640
P 0 BOX 131
DACONO, CO 80514
HELEN ANEST SUSURAS 705048 0.00019930 RI M
P 0 BOX 84 0.00019930
DACONO, CO 80514
EDWARD MICHAEL MARTINEZ 705114 0.00013290 RI SD
433 MCCLURE AVE 0.00013290
FIRESTONE, CO 80520
BOB R SUTHERLAND 705118 0.00009970 RI SD
JEFF R DELL 0.00009970
VICTOR RAYMOND MOCULESKI 705218 0.00006640 RI SU
ALEX J MOCULESKI, J/T 0.00006640
P 0 BOX 22
DACONO, CO 80514
VICTOR & MARY MOCULESKI J/T 705276 0.00006640 RI ST
P 0 BOX 22 0.00006640
DACONO, CO 80514
MAE GREEN AC 369050 705283 0.00820940 RI M
COLO ST EMPLOYEES C U 0.00820940
1390 LOGAN ST
DENVER, CO 80203
CHARLES P ARVAS 705458 0.00013290 RI M
2530 16TH AVE 0.00013290
EXHIBII 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name & Address . OWNER NO . INTEREST.. . TYPE .. . CODE
GREELEY, CO 80631
THOMAS L FRYE 705510 0.00006640 RI SC
P 0 BOX 55 0.00006640
DACONO, CO 80514
RALPH JOSEPH MONTOUR 705574 0.00006640 RI SC
3759 FRANKLIN ST 0.00006640
DENVER, CO 80205
GERRIT & BETTY VEENENDAAL JR 705707 0.00009960 RI M
39 DOUGLAS DRIVE SOUTH 0.00009960
BROOMFIELD, CO 80020
WAYNE KIRKPATRICK 705805 0.00006640 RI M
P 0 BOX 146 0.00006640
DACONO, CO 80514
STUART A SMITH 705827 0.00820950 RI M
804 EUCLID AVE 0.00820950
BOULDER, CO 80302
CHARLES B WILLIAMS 705914 0.00006640 RI M
P 0 BOX 203 0.00006640
RAMONA, CA 92065
CLIFTON L ELLIOTT SR & 706058 0.00013280 RI SD
AVIS L ELLIOTT 0.00013280
P 0 BOX 56
DACONO, CO 80514
LINNOLA B BURY 706065 0.00006640 RI M
4978 WELD CO RD 59 0.00006640
KEENESBURG, CO 80643
A V VICKERY TRUST 706229 0.00694830 RI M
AC 09366006 0.00694830
INDEPENDENT TRUST COMPANY
507 CANYON BLVD.
BOULDER, CO 80302
RICHARD C & VERNA WILLIAMS 706311 0.00006650 RI M
10912 LYNN AVE 0.00006650
LAFAYETTE, CO 80026
ROBERT GALLOWAY 706338 0.00250700 OR M
3400 S IVY WY 0.00250700
DENVER, CO 80222
BIRDIE ANN TEATER 706387 0.00006640 RI SD
325 3RD ST 0.00006640
P 0 BOX 8
DACONO, CO 80514
WELD COUNTY COLORADO 706413 0.00630230 RI M
C/O BOARD OF CTY COMMISSIONER 0.00000000
915 10TH ST
GREELEY, CO 80632
ROBERT & EVANGELINE MORENO J/T 706555 0.00006640 RI SD
P 0 BOX 156 0.00006640
DACONO, CO 80514
RALPH CALVIN 708422 0.00017800 RI M
RUTH CALVIN 0.00017800
1808 N. SCOTTSDALE ROAD
TEMPE, AZ 85281-1515
MARTI I LUDEMAN DAVIS 708742 0.00001660 RI SD
RDk3 BOX 517 0.00001660
EXHIBIT 'A'
113263022 - GLENS VV 06-14 (J)
OIL AND/OR GAS DIVISION ORDER
DECIMAL INTEREST PAY
Name 8 Address OWNER NO . INTEREST.. . TYPE .. . CODE
MUNCY, PA 17756
VICKIE ROUSE AS CUSTODIAN 708743 0.00004980 RI SD
FOR C DAVIS,M DAVIS 8 A DAVIS 0.00004980
8706 VERONA TRAIL
AUSTIN, TX 78749
DALCO INC 714852 0.00235200 RI M
2450 CENTRAL AVENUE 0.00235200
SUITE A-1
BOULDER, CO 80301
DALCO INC 714852 0.03212820 WI M
2450 CENTRAL AVENUE 0.03212820
SUITE A-1
BOULDER, CO 80301
103 records Listed
PATANA
OIL & GAS CORPORATION
1625 Broadway Suite 2000
Denver, Colorado 80202
(303) 389-3600
(303) 389-3680 Fax
Dear Interest Owner:
Please read carefully before signing the enclosed oil and gas division orders:
I. Your interest as shown on this instrument should not be altered in any way unless accompanied by docu-
mentary evidence to support the change. We may reject any division orders changed without our ap-
proval. Do not detach Exhibit "A", if applicable.
2. Furnish in writing any change of address information and include your signature. For change in owner-
ship, furnish copies of properly filed and recorded legal documents affecting title of interest ownership
under which payment is made. Provide a letter describing effect of change.
3. Sign your name EXACTLY AS IT APPEARS ON THE INSTRUMENT. Please have your signature
witnessed by two separate parties.
4. If signing for a corporation, signature must be attested, corporate seal affixed and title of signatory party
shown.
5. If signing for t partnership, all partners must sign, unless signed by an authorized partner and we are
furnished a certified copy of his/her authority.
6. If the instrument is signed by an agent, attorney-in-fact, guardian, estate representative, trustee or any
party other than the named interest owner, we must have evidence of the rights vested in the signatory
party.
7. If an interest is shown jointly for more than one person, each party must sign the division order in the
manner that his or her name is shown thereon. In the event one party has been designated agent for the
joint interest shown or he/she has been granted a power of attorney for the other party(ies), we must have
evidence to this; effect.
8. Insert your Tax Identification Number or Social Security Number, whichever is applicable, in the space
provided. We may withhold payment until such number is received.
9. Confirm the address to which checks are to be mailed. If different, please provide the correct address.
You should nom:ify us promptly of any changes in your mailing address.
10. The number assigned to this property can be found in the upper right corner of the form. The number
will be used to designate this property on your revenue check. Refer to the property number when corre-
sponding.
11. Return the executed instrument without delay to the address below. KEEP ONE COPY FOR YOUR
RECORDS.
PATINA OIL & GAS CORPORATION
ATTENTION: KAREN MURRAY
1625 BROADWAY, SUITE 2000
DENVER, CO 80202
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