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Home My WebLink About20191970.tiffCOPY To: Extraction Oil and Gas. Inc. 370 17t1i Street, Suite 5300 Denver, CO 80202 Well/Property Name: Well API Number: Well/Property Number: County and State: Spacing Unit Gross Acres: Spacing Description: See Exhibit on Reverse Side See Exhibit on Reverse Side See Exhibit on Reverse Side Weld, Colorado See Exhibit on Reverse Side See Exhibit on Reverse Side Production Type: X Oil X Gas X . Other NADOA Model Form Division Order (Adopted 9/9Si— DIVISION ORDER Date: April, 2019 Analyst: C. Coupens RECEIVED Malin 2gg-l02G APR 3 0 2010 API 05-/23-LP7`4 WELD COUNTY COMMISSIONERS Owner Number Owner Name WELD COUNTY COLORADO Tax Identification Interest Type Interest Decimal 4317 PO BOX 758 XXX-XX-0813 RI See Reverse Side GREELEY, CO 80632 The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by Extraction Oil and Gas, Inc. ("Payor"). Payor shall be notified, in writing, of any change in ownership. decimal interest. or payment address. All such changes shall be effective within 60 days of notification from Payee. 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. A facsimile or scanned copy of a signed copy of this Division Order shall be deemed an original. • Federal Law requires you to furnish your Social Security or Taxpayer Identification Number. BOARD OF ATTEST: CLERK BY: DEPUTY CLERK C©hslur,'v P+yoVc. vc,2,02- /9 5-as-��, 2 Zu19' Weld County Government 1150 "O" Street Greeley, CO 80634 Phone: 970-336-7204 Fax: 970-336-7233 „,Tax ID: 84-6000-813 2019-1970 C( ) File ID: 2862 Owner ID: 4317 Well Well Name Well API Well Spacing 2862 MERLIN 29E -10-02C 0512347466 6N 67W 20: S/2SW/4, SEC 29: N/2N/2, SEC 28: NW/4NW/4 Paycode Legend M= SDO SID ST Account is current for this well and in PAY status We require this executed Division Order in order to release funds for this well. We require this signed Division Order and a W-9 form to release funds for this well. Your account is in title suspense and needs resolution before payment can be made. Unit Acres 277.320 Pay Decimal code Interest SDO 0.00168776 File ID: 2862 Owner ID: 4317 Please see the calculations from the title opinion below for the Merlin 29E -10-02C. Interest Owner Name Weld County Weld County Weld County Thanks! Caitlin Coupens LEO S3 LEO ?Li 32 Division Order Analyst I Extraction OH & Gas 370 .17th Street, Sui .e 5300 Denver/ CO80202 D:720-354-4583 Ti Interest Type LRI LRI LRI Tract No. 8 27 30 Tract Acres 1.88 0.33 0.32 Leased Mineral Int. Unit NRI 4046 794 100.000000% 18.500000% 4061587 100.000000% 18.500000% 4001$88 100.000000% 18.500000% 0.125415% 0.022014% 0.021347% 0.168776% 'F 5/16/2019 nf COGIS - WELL Information Scout Card Related C3/4, MIT Surface Loc tln Data for API # 05-123-47466 G 11/23/2018 Well Name/No: Operator: Status Date: 11/23/2018 FacilitylD: 456262 County: WELD #123 Field: Planned Location GIS a Doc ]K COA Wellbore Aga Orders Status: MERLIN #29Em10-2C (click well name for production) EXTRACTION OIL & GAS INC - 10459 Federal or State Lease #: LocationlD: Location: WATTENBERG - #90750 Elevation: 2322 FNL 365 FWL Lat/Long: 40.458648/-104.925162 456260 SWNW 29 6N67W 6 PM 4,817 ft. Lat/Long Source: Field Measured Job Date: 2/23/2019 Reported: 3/19/2019 Days to report: 22 Chemical Disclosure Registry Job End Date: 2/25/2019 Welibore Data for Sidetrack #00 Spud Date: 11/23/2018 Spud Date is: Sib Y re Per Edit HORIZONTAL Permit #: Expiration Date: Prop Depth/Form: 13008 Surface Mineral Owner Same: Mineral Owner: FEE Surface Owner: FEE Unit: Unit Number: Formation and Spacing: Code: CODL , Formation: CODELL , Order: , Unit Acreage: 280, Drill Unit: GWA Casing: String Type: CONDUCTOR , Hole Size: 24, Size: 16, Top: 0, Depth: 80, Weight: 42 Cement: Sacks: 100, Top: 0, Bottom: 80, Method Grade: Casing: String Type: SURF , Hole Size: 12.25, Size: 9.625, Top: 0, Depth: 1500, Weight: 36 Cement: Sacks: 400, Top: 0, Bottom: 1500, Method Grade: Casing: String Type: 1ST , Hole Size: 8.5, Size: 5.5, Top: 0, Depth: 13008, Weight: 20 Cement: Sacks: 1677, Top: 1500, Bottom: 13008, Method Grade: Weilbore Completec Completion Date: N/A Measured TD: Measured PB depth: True Vertical TD: True Vertical PB depth: Top PZ Location: Sec: 29 Twp: 6N 67W Footage: 431 FFNLL 460 FFWLL Bottom Hole Location: Sec: 28 Twp: 6N 67W Footages: 542 FFNLL 300 FFWLL Formation Log Top Log Bottom Completed information for formation 1st Production Date: Status Date: Commingled: Formation Name: Tubing Size: Tubing Packer Depth: Open Hole Top: No Initial Test Data was found for formation N-COM a 11/1/2018 11/1/2018 NOT COMPLETED No Perforation Data was found for formation N- COM N-COM Choke Size: Open Hole Completion: Production Method: Status: Tubing Setting Depth: Tubing Multiple Packer: Open Hole Bottom: Status: DG 11/23/2018 NOTICE 7/24/2020 5:28:29 PM Depth Depth Cored DSTs Status: DG 11/1/2018 DG cogcc.state.co.us/data.html#/cogis 1/1 Oil & Gas INST UCTI NS T INTEREST WNE ` S HIS IS Miff AN iF 9 T Pl CHASE OR L d S tUR MINERAL RIGTSO You are receiving this paperwork because Extraction Oil & Gas is currently producing, or will be in the near future, oil and/or gas from a well(s), in which you have been identified as an interest owner. In order to receive your royalty payments, the enclosed paperwork must be signed and returned. PLEASE REVIEW, EXECUTE i'NE COPY AND RETURN TO OUR OFFICE, AND KEEP NE COPY FOR YOUR RECORDS. PLEASE DO NOT DETAC THE EXHIBIT FROM THE DIVISION ORDER IF ONE IS INCLUDED. N • TE: Royalty payments are made at the end of each month when the amount due to you has reached $100 or more. The attached document should not be altered in any way except to correct spelling errors, unless accompanied by documentary evidence to support the change. 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 fixed and title of signatory party reflected. 4. If signed by an agent, attorney -in -fact, guardian or any party other than the named interest owner, a certified copy of the power of attorney or other evidence of such party's right to sign must be furnished. 5. Division Orders for partnerships must be executed by all partners or by an authorized partner. A certified copy of the instrument giving said partners authority to sign must be furnished. 6. Federal l.w requires th :tt you fur Nish A correct social security or taxpayer identification nubero 'a.ilure to comply will result in 28% tax withholdi g required by the I aternal Revenue Service a s d will not be refunded by Extractions You rn 44 y also be subject ti' a further penalty levied by the Inter al Reven e Service. If your tax identification number is pre-printed on the enclosed Division Order, a W-9 form is not required. If no tax identification number is listed OR the pre- printed tax identification number is incorrect, the closed W-9 form must be completed and returned with your Division Order. 7 If the Division Order contains an incorrect mailing address, your correct mailing address should be noted on the Division Order to insure prompt receipt of production proceeds. Please print the correct mailing address using no abbreviations. 8. The "Return" portion should be returned to: EXTRACTION *IL AN GS9 INC. 370 17th Street, Suite 5300 .l e ver9 Colorado 80202 Att=ia o tivision =7>s °sl+a trs 9 Should you have any further questions regarding the enclosed Division Order, please contact Owner Relations at 1-855-412-6501 or via email at DivisionOrders@ExtractionOG.com. 10. Please visit our website at ExtractionOG.com to learn more about Extraction Oil and Gas. EXTRACTION OIL AND GAS, INC • 370 17th STREET, SUITE 5300 • DENVER, CO 80202 TT STAFF 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): Merlin 29E-10-020 File Location(s): 1,10330 LE0334 LEc33 DATE a Bruce 13arker - County Attorney pre'? f5, P NOTES: 2.53 mineral acres/ 27732 acres spacing unit * 18.5% = .00168776 MATCH Hello