HomeMy WebLinkAbout20191969.tiffNADOA Model Form Division Order (Adopted 9/95)
DIVISION ORDER
To: SRC ENERGY, Inc.
1675 Broadway, Suite 2600
Denver, CO 80202
Attention: Division Orders
Property Number: BOO13C-6-M
Property Name: BOOMERANG 13C -6-M
Operator: SRC ENERGY INC WELD COUNTY County and State: Weld, Colorado COMMISSIONERS
Description: Township 5 North, Range 66 West - Sec 5: NW; W2NE; Sec 6: N2
Township 5 North, Range 67 West - Sec 1: E2NE - CONTAINING 633.55 ACRES, MORE OR LESS
Date: March 15, 2019
Effective Date: 1st Production
Production: X
Oil X
Apr 65-i23-453RC(
Gas X
Other: all products
RECEIVED
MAR 2 9 2019
Owner Name and Address:
Owner Number: 3883
Board of County Commissioners of the County Type of Interest: RI
1150 O Street PO Box 758 Decimal Interest: 0.00012233
Greeley, CO 80632
Notes:
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above.
Payor shall be notified, 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.
Payor 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 Payor any amount attributable to
an interest to which the undersigned is not entitled.
Payor may accrue proceeds until the total amount equals $100.00, 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 Payor may have certain statutory
rights under the laws of the state in which the property is located.
SIGNATURE
BOARD OF
ATTEST
CLER
BY:
DEPUTY CLER '' 0 THE BOAR
;AY 2 2 2019
Weld County Government
1150 "0" Street
Greeley, CO 80634
Phone: 970-336-7204
Fax: 970-336-7233
Tax ID: 84-6000-813
Federal Law requires you to furn a Security or Taxpayer Identification Number.
Failure to comply will result in 28% tax withholding and will not be refundable by
ehb
s —ate— tc't
Retain this copy for your records
2019-1969 6)
�0493
® ER INTEREST REPORT Well Group
Date Printed: 4/16/2019
Miner a nt. x Tract Ac9 E.
Owners Over Riding Royalty
Owner's Working Interest
OWNER NAME Weld County
Unit
Desc
SU 28.13 Short 13C -6-M
tavfeaggid W4 Sr; &W,Vigia#04, V:zrc . evaagrReSitea jr. , swra ,
5N -66W Sec. 5: NW/4, W/2NE/4; Sec. 6: N/2
True
True FM Desc CDNI
Tract iD 81
SU 28.13 Short 13C -6-M
liratceita
SU Tracts in which Owner has an interest 1
NENE Tract Ac. Total Acres
in Unit in Unit
0.62 ® 633.55
Owners Lease Royalty Interest Mineral Acres Mineral Int. Lse Roy Tr Factor
0.62000000 1 y 0.125 x 0.00097861 =
ORR 0.00000000 x 0.00097861 =
0 NRIwi 0.00000000 y 0.00097861
Tracts Proportion
of Unit (Tr Factor)
JIBI me rest` fr Tract. (v 1.*TrFactor)
0.000979
Rev Interest
0.00012233
0.00000000
0.00000000
Rev I erect In SU front this Tra t 0,00c `.2233
Owners Interest in Spacing Unit
SU 28.13 Short 13C -6-M
Wells in Spacing Unit
Boomerang 13C -6-M
WI TOTAL
0.00000000
�IIIR Rev Int TOTAL
0.00012233 + 0.00000000 + 0.00000000 +
Page 3 of 3
5/16/2019
LL 1 ft bati n
a
COGCC Data
Scout
Car
Related In p..
MIT 0 GIS ,Doc Etc A
Surface Location Data for API # 0®123-45398
Well Narne/No:
Operator:
Status Date:
FacilitylD:
County:
Field:
Planned Location
¶Wellbore
fe
rders
Status: "``R 10/1/2018
Boomerang #13C -6-m (lack well name for production)
SRC ENERGY INC - 10311
10/1/2018
452095
WELD #123
Federal or State Lease #:
LocationlD:
Location:
WATTENBERG - #90750 Elevation:
1466 FAIL 2327 FWL Lat/Long: 40.433126/-104.803582
Job Date: 8/28/2018 Reported: 10/30/2018
Chemical Disclosure Registry Job End Date: 9/2/2018
Wellbore Data for Sidetrack #00
Spud Date:
ell or Permit
Permit #:
Prop Depth/Form:
Mineral Owner:
Unit:
Formation and Spacing:
Casing:
Cement:
Casing:
Cement:
Casing:
Cement:
!lore plleted
Completion Date: N/A
Measured TD:
True Vertical TD:
Top PZ Location: Sec: 5 Twp: 5N 66W
Bottom Hole Location: Sec: 6 Twp: 5N 66W
Formation Lo , T p
Complet d information for formation
12/18/2017
15688
FEE
Spud Date is:
HORIZONTAL
Expiration Date:
Surface Mineral Owner Same:
Surface Owner:
Unit Number:
Code: CODL , Formation: CODELL , Order: , Unit Acreage: 654, Drill Unit: GWA
String Type: CONDUCTOR , Hole Size: 24, Size: 16, Top: 0, Depth: 40, Weight: 65
Sacks: 35, Top: 0, Bottom: 40, Method Grade:
String Type: SURF , Hole Size: 13.5, Size: 9.625, Top: 0, Depth: 1750, Weight: 36
Sacks: 531, Top: 0, Bottom: 1750, Method Grade:
String Type: 1ST , Hole Size: 8.5, Size: 5.5, Top: 0, Depth: 15688, Weight: 20
Sacks: 1961, Top: 0, Bottom: 15688, Method Grade:
438622
N ENW 5 5N66W 6 PM
4,770 ft.
Lat/Long Source: Field Measured
Days to report: 58
10/1/2018
=C
1st Production Date: 12/1/2017
Status Date: 10/1/2018
Commingled:
Formation Name: NOT COMPLETED
Tubing Size:
Tubing Packer Depth:
Open Hole Top:
No Initial Test Data was found for f rmation NCOM
No Peri
C
0
ration Data was found for formation N®
Measured PB depth:
True Vertical PB depth:
Footage: 1865 FFNLL 2487 FFWLL
Footages: 1744 FFNLL 150 FFWLL
Log Bottom
M
Choke Size:
Open Hole Completion:
Production Method:
Status:
Tubing Setting Depth:
Tubing Multiple Packer:
Open Hole Bottom:
Status: PR
N OTICE
9/6/2019 5:13:59 PM
FEE
Depth
Depth
Status: PR
P R
red DSTs
1011/2018
cogcc.state.co.us/data.html#/cogis 1/1
SRC ENERGY
Dear Interest Owner,
Enclosed are copies of Division Orders for your approval and execution. The purpose of this Division Order is to provide you
information about your ownership and obtain certification that you are the correct person whom payments for this interest
should be made.
If you are receiving a Division Order from SRC Energy, Inc. for the first time, please be advised that we are the operator and
a well has started producing or there was notice of transfer in ownership.
If your name and interest are correctly shown:
1. Sign your name as shown on the Division Order.
2. If your name has changed due to marriage or divorce, execute the Division Order using your present name and
furnish a copy of the marriage certificate or divorce decree.
3. If signing for a corporation, signature must be attested, corporate seal affixed and of signatory party reflected.
4. If signed by agent, attorney -in -fact, guardian or any party other than named interest owner, certified copy of the
power of attorney or other evidence of such party's right to sign must be
furnished.
5. Please provide your correct Social Security Number or Tax Identification Number, failure to comply will result in a
tax withholding of 28% on all production proceeds due to you. You may also be subject to a further penalty levied by
the Internal Revenue Services.
6. Your royalty check will be sent to the address listed on the Division Order. Please verify that the address is correct.
If there is an error in your address or your address has changed, please note the correction on the space provided.
7. Please sign and return the top copy of the Division Order to:
SRC Energy, Inc.
1675 Broadway, Suite 2600
Denver, CO 80202
8. Should you have any further questions regarding the enclosed Division Order, please contact
Ellen Britt at (720) 616-4329.
Sincerely,
Ellen H. Britt
Division Order Manager
SRC Energy, Inc.
ebritt@SRCEnergy.coln
www.svrginfo.com
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 and legal
description.
Well Name(s): Boomerang 130-6-M
File Location(s): 110493
DATE: Ay
Bruce Barker - County Attorney
I Vie
NOTES: .62 mineral acres/ 633.55 acres spacing unit * 12.5% _ .00012233 MATCH
Weld County received this mineral interest via a special warranty deed that was received due to purchasing a
ROW. All documentation lines up.
Hello