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Home My WebLink About20191968.tiffNADOA Model Form Division Order (Adopted 9/95) To: SRC ENERGY, Inc. 1675 Broadway, Suite 2600 Denver, CO 80202 Attention: Division Orders DIVISION ORDER Date: let19)05123-L Effective Date: 1st Production April22, 2019 Property Number: BOO25N-3A-11BOO25N-3B-L Property Name: B_OOMERANG 25N -3A -L, BOOMERANG 25N -J -L Operator: SRC ENERGY C p t o 5- 12 3 "'l -15°O`1 County and State: Weld, Colorado J Description: Township 5 North, Range 66 West Township 5 North, Range 66 West Sec 32: S2SE, SESW, Sec 33: S2S2, Sec 34: S2SW, SWSE Containing 853.759 acres, more or less RECEIVED Sec 3: N2NW, NWNE, Sec 4: N2N2, Sec 5: N2NE, NENW Production: X Oil X Gas X Other: all products APR 2 9 20i9 WELD COUNTY COMMISSIONERS Owner Name and Address: Weld County, Colorado P.O. Box 758 1150 O Street Greeley, CO 80632 Notes: Owner Number: 3415 Type of Interest: RI Decimal Interest: 0.00027916 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 $100.00, or pay annually, whichever occurs first, or as required by applicable state statute. This Division Order does not amend any lease or operating agreement between the undersigned and the lessee or operator or any other contracts for the purchase of oil or gas. In addition to the terms and conditions of this Division Order, the undersigned and Payor may have certain statutory rights under the laws of the state in which the property is located. SIGNATURE: BOARD OF ATTEST CLER BY: _ L, DEPUTY CLERK T THE db MAY S, CH Weld County Government 1150 "O" Street reeley, CO 80634 hone: 970-336-7204 x: 970-336-7233 x ID: 84-6000-813 Federal Law requires you to furnish yo'urity or Taxpayer Identification Number. Failure to comply will result in 28% tax withholding and will not be refundable by Pavor C o hs_t.x\* P\cveNo4 s-as-kc't Retain this copy for your record 2019-1968 (1 E C/572- sal OWNER INTEREST REPORT Well Grouo OWNER NAME [Weld County, Colorado "V Unit Desc Az: boob .L Z - ":::J;:\':F ly'L2tiAj}xy; ; »»�?};;:: Ov a: s,`...,yt � g]2L� - tb!'-\ t>2r-`:7` 'c;'�'- 5`;`,,c:#<ira ;i<i ....:......:.va.;..::.a ::...�:2l7Z,pp y tt� ;x'.' .::v.:o::::e::::::::::•:}: C •::�„ RVxIR�RtCC(tCi�33.�..�'�$?ta-''y_-ti3.;s:;.xa::::;;'.-:;,'.v.;;;:;.w.-`2::AU0�ZG'C�1,i'�'ti"kY�{A��."E�eft`.t�%'�-fi;)s:::;:,::.-_::+:.:::;.;:c:�-_...,e...kax..a�\i\(�OY.`RCz.RC<.'fthL�t r�R.1.a.,..,:.3:.:...::'c'r'<':x�;a.�.::: qi 88.1. North Boundary :............v:.�:.::::....:....a......:,.. ..: t-::n-i-%,w.i:..w._::f:l:::.�J............. ... vw:iS:::uv..:}:w.izi;::iiiiiiiiv +x' - c:;:a:::::::;:::vw..:;,aCa�\G07a�� t .'°�.:::..�,a..-::ii;.C:S:2;3;:::::::A\au::aaa��+}h ....:..�_..�px;:ms-:-x;--;..,;:a;:::», w Date Printed: 5/14/2019 aa.a w. Vj� Y;yYay::--3:-i:•;a;; :a.:::•: ;uxi;w,c:3��cC� 853.759151 .s.tz:e.ne:ja]'.a R<f . RNA,'tifi.:iap}giii.:-:i;-ri{: age,U umv;Y$Y} DSU 88.11 Boomerang North Boundary Wells 6N -66W, Sec 32: S2SE, SESW; Sec 33: 5252, Sec 34: S2SW, SWSE; 5N -66W, Sec 3: N2NW, N°/NE; Sec 4: N2N2; Sec 5: N2NE, NFNW True Gas True FM Desc CDNI u Tracts w f Owner Ja has an interest � JL* 6W $.N�h. 9. • •. SU Tracts in which Owner has an inte�Y Vm s� I e 1 r Tract ID 815 88.11 North Boundary Sec 1...e aseRecNo •1939810 Owners Lease Royalty Interest Mineral Inc . x Tract Acres Owners Over Riding Royalty Owner's Working Interest WI Y 331 trQQ, Mineral Acres 1.43000000. SWSE Mineral kit., ORR NIIvi Tract Ac. Total Acres in Unit in Unit 1.43 853.7592 Lse Roy Tr Factor 1 x 0.166671 x 0.00167495 = [0.000000001 x [0.00167495 6...0.00000000 x [0.00167495 Tracts Proportion of Unit (Tr Factor) 0.001675 Rev Interest 0.000279161 0.00000000 _ Lo.000000pal Owners Interest in Spacing Unit WI TOTAL 88.11 North Boundary j 0.00000000 Wells in Spacing Unit Boomerang 125N -3B4 LOR 0.0OO27916 NRI 0.00000000, + O R R 0.00c 000001 Rev Int TOTAL 5/16/2019 COGCC Data r Scout Card Related Insp. MIT GIS oc urface Location Data for API # 05-123-46000 Well Name/No: Operator: Status Date: 10/1/2018 FacilitylD: 453240 County: WELD #123 Field: Planned Location n. Chemical Disclosure Registry Job End Date: 8/2/2018 [COt Q Weilbore Status: PR Boomerang #25N -3A -L (click well name for production) SRC ENERGY INC - 10311 Federal or State Lease #: LocationlD: Location: WATTENBERG - #90750 Elevation: 1332 FNL 2327 FWL Lat/Long: 40.433495/-104.803535 W f o re D Spud Date: � Ws*r :E P Permit #: Prop Depth/Form: Mineral Owner: Unit: Formation and Spacing: Casing: Cement: Casing: Cement: Casing: Cement: ellre Compiate Completion Date: Measured TD: True Vertical TD: Top PZ Location: Sec: 5 Twp: 5N 66W Bottom Hole Location: Sec: 3 Twp: 5N 66W Formatl ; n Log T _ p Job Date: 7/31/2018 Reported: 9/7/2018 for Sidetrack #00 ermit 12/30/2017 17554 FEE Spud Date is: HORIZONTAL Expiration Date: Surface Mineral Owner Same: Surface Owner: Unit Number: Code: NBRR , Formation: NIOBRARA , Order: , Unit Acreage: 848, 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: 17554, Weight: 20 Sacks: 2152, Top: 0, Bottom: 17554, Method Grade: N/A ga, Orders 10/1/201 438622 NENW 5 5N66W 6 PM 4,770 ft. Lat/Long Source: Field Measured Days to report: 36 Status: PR NOTICE 10/1/2018 11/29/2019 1:43:10 PM FEE Measured PB depth: True Vertical PB depth: Footage: 300 FFNLL 2487 FFELL Depth Footages: 314 FFNLL 2481 FFWLL Depth Completed infrrnation for formation NCO 1st Production Date: Status Date: Commingled: Formation Name: Tubing Size: Tubing Packer Depth: Open Hole Top: No Initial Test Data was f 12/1/2017 10/1/2018 NOT COMPLETED and for formation NCOM No Perforation Data was found for formation COM ottorn Choke Size: Open Hole Completion: Production Method: Status: Tubing Setting Depth: Tubing Multiple Packer: Open Hole Bottom: Cored Status: PR 10/1/201 PR STs cogcc.state.co.us/data.html#/cogis 1/1 5/16/2019 f r COGCC Data Scout Card Surface L ocatl n Dat Well Name/No: Operator: Status Date: FacilitylD: County: Field: Planned Location Related Insp. IT O GIS a. DOC RKC•A 9rWeIIbore for API # 05-123-45999 Status: Boomerang #25N -3B -L (click well name for production) SRC ENERGY INC - 10311 10/1/2018 453239 WELD #123 Federal or State Lease #: LocationID: Location: WATTENBERG - #90750 Elevation: 1317 FNL 2327 FWL Lat/Long: 40.33536/-104.803529 Job Date: 7/13/2018 Reported: 8/24/2018 Chemical Disclosure Registry Job End Date: 7/20/2018 W-IIbore Data for Sidetrack #00 Spud Date: Wellb Permit #: Prop Depth/Form: Mineral Owner: Unit: Formation and Spacing: Casing: Cement: Casing: Cement: Casing: Cement: eU * re mat on Completion Date: Measured TD: True Vertical TD: Top PZ Location: Bottom Hole Location: Formation t d 12/31/2017 17685 FEE Spud Date is: HORIZONTAL Expiration Date: Surface Mineral Owner Same: Surface Owner: Unit Number: Code: NBRR , Formation: NIOBRARA , Order: , Unit Acreage: 848, 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: 17685, Weight: 20 Sacks: 2171, Top: 0, Bottom: 17685, Method Grade: `e Orders 10/1/2018 438622 NENW 5 5N66W 6 PM 4,770 ft. Lat/Long Source: Field Measured Days to report: 35 10/1/2018 N/A Sec: 5 Twp: 5N 66W Sec: 3 Twp: 5N 66W L F; g Top ompleted inform 1st Production Date: Status Date: Commingled: Formation Name: Tubing Size: Tubing Packer Depth: Open Hole Top: No Initial Test Data was f s N C Perforation I I.:; Status: PR NOTICE 11/29/2019 1:43:10 PM FEE Measured PB depth: True Vertical PB depth: Footage: 154 FFNLL 2487 FFELL Depth Footages: 147 FFNLL 2485 FFWLL Depth LolEri art: fi�� ation for formation N -CO 12/1/2017 10/1/2018 NOT COMPLETED and for formation N-COM ata was found for formation J�• 1 4� J Choke Size: Open Hole Completion: Production Method: Status: Tubing Setting Depth: Tubing Multiple Packer: Open Hole Bottom: e Core Status: PR PR DSTs 10/1O018 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 Dijana Bishop at (720) 616-4362. Sincerely, Dijana Bishop Division Order Lead SRC Energy, Inc. dbishop@SRCEnergy.com www.syrginfo.com UNT NEY TAFF APP 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 25N -3 -A -L Boomerang 25N -3B -L File Location(s): LE0072 Bruc - arker - County Attorney �r frcese DATEo 1 NOTES: 1.43 mineral acres/ 853.759151 acres spacing unit * 0167495% = °00027916 MATCH Hello