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HomeMy WebLinkAbout20191856.tiffNADOA Model Form Division Order (Adopted 9/95) DIVISION ORDER To: SRC ENERGY, Inc. 1675 Broadway, Suite 2600 Denver, CO 80202 Attention: Division Orders Date: September 24, 2018 Effective Date: 1st Production Property Number: AG5C-31-L Property Name: AG 5C -31C -L Apt D6 -12 / / J / ) 47 Operator: SRC ENERGY INC `� �J County and State: Weld, Colorado Description: Township 6 North, Range 66 West Sec 31: S2N2, Sec 32: S2N2, Sec 33: SWNW Production: X Oil X Gas X Township 6 North, Range 67 West Sec 36: SENE Containing 420.70 acres, more or less Other: all products 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: 0.00007036 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 CLERK 0 THE BOA Weld County Government 1150 "O" Street Greeley, CO 80634 Phone: 970-336-7204 Fax: 970-336-7233 Tax ID: 84-6000-813 Federal Law requires you to ecurity or Taxpayer Identification Number. Failure to comply will result in'"'::"ithholding and will not be refundable by Payor 2019-18566 .) db Retain this copy for your records / 4 si2c. lEo1+2o OWNER INTEREST REPORT Well Group Ag wells Date Printed: 3/6/2019 OWNER NAME Weld County REPORT FOR WELLS BELOW Ag 5C -31-L Unit Name 33.14 Total Acres in Spacing Unit (SU Acres) # of Tracts Owned in SU 2 Unit 6N -66W Sec 31: S2N2; Sec 32: 52N2; Sec 33: SWNW Desc 6N -67W Sec 36: SENE Owners TOTAL Interest in Each Well 420.7 :gin ...rm. , ',:r,G..-..r..•c- See.. ract Detail Below Workin Int LOR NRI ORR 0.00000000 0.00007036 + 0.00000000 + 0.00000000 + Rev Int TOTAL 0,00007Q36 TraL U►. tail Tract ID 4 Sec LeaseRecNo 4234137 Owners Lease Royalty Interest Tract Detail Tract ID 42 Sec LeaseRecNo 4234136 32 trQCI SWNW Mineral Int. Lse Roy 1 x 0.185 x 32 trO,O, SWNW Czel ,L Owners Lease Royalty Interest Tract Ac. in Unit 0.06 Tr Factor • Total Acres in Unit 0.00014262 = Tract Ac. in Unit Tracts Proportion of Unit (Tr Factor) 420.7 = 0.00014262 Rev Interest 0.00002638 Total Acres in Unit Tracts Proportion of Unit (Tr Factor) 0.1 - 420.7 = 0.0002377O Mineral Int. Lse Roy Tr Factor 1 y 0.185 x 0.00023770 Rev Interest • OWNER INTE EST REPORT Group ag Date Pcrinted: 10/26/2018 33.14 33.14 OWNER NAME Weld County '�t`ttXiv_T..y�yZ,KtSf'r3Y�•.�J_VMf�E�":'�7YA�•.a2". s.1f�2:fi' 33.14 '�r3cW 1' .wm�oM m."1" :1•NT,vggp•mmepmf<11R<^l cw.s^4c.n...Iscoms:roya,:fifMpope:o.:1 vrau vA'm'.JONO!M11:J1Ade+%:.(^.Il4.EtlW,{iErti !1R Unit 6N -66W Sec 31: 52N2; Sec 32: 52N2; Sec 33: SWNW Desc 6N -67W Sec 36: SENE Oil True Gas True FM Desc CDNI spt 420.7 SU Tracts in which Owner has an interest 2 Tract ID 4 Sec Owners Lease Royalty Interest Mherai Int. x Tract Acres Owners Over Riding Royalty Owner's Working Interest WI JIB Interest from Tract (WI*Tr :Factor) 32 triall SWNW Tract Ac. Total Acres in Unit in Unit Min-erai Acres 0.06000000 Tract 10 42 Sec 0 0 0.06 • Mineral Int, Lse Roy 1 x 0.185 x O R R 0.00000000 ,( H i v' i 0.00000000 y 420.7 Tracts Proportion of Unit (Tr Factor) Tr Factor 0.00014262 = 0.00014262 0.00014262 = Total Rev Interest in SU from this Tract 32 trQ,, SWNW Tract Ac, Tota=Acres (�} n t in Unit it i N i �. 7� l � 1 �! 1� Owners Lease Royalty Interest Kilinerai Acres inerai x Tract Acres Owners Over Riding Royalty Owner's Working Interest IVI JIB Interest from Tract (WI*Tr Factor) 0.10000000 0 Mineral 0.000143 Rev Interest 0.00002638 0.00000000 0.00000000 Tracts Proportion of Unit (Tr Factor) 0.1 m 420.7 = 0.000238 se Roy Tr Factor 1 x 0.185 y 0.00023770 = ORR 0.00000000 y 0.00023770 = N R. iw i 0.00000000 x 0.00023 770 Total Rev Interest in SU from this Tract Rev interest 0.00004397 0.00000000 0.00000000 0.00004397 Owners Interest in Spacing Unit 33.14 Wells in Spacing Unit Ag 5C -31-L WI TOTAL 0.00000000 Page 5 of 8 Ln R NRI ORR Rev Int TOTAL 0.00007036 + 0.00000000 + 0.00000000 + 0,000070 J 5/10/2019 r rn COGIS - WELL Information Well Name/No: Operator: Status Date: FacilitylD: County: Field: Planned Location As Drilled Location Scout Card Related Insp. MIT GIS II , Doc Rt COA Mfr WeNbore Sur sce Location Data for API # 05-123-44873 Status: P g State #5C -31-L (Click well name for production) SRC ENERGY INC - 10311 7/1/2018 Federal or State Lease #: 450682 LocationlD: WELD #123 Location: WATTENBERG - #90750 Elevation: 994 FNL 558 FEL Lat/Long: 40.449196/-104.794411 Footages Not Available Lat/Long: 40.449196/-104/94411 Job Date: 1/29/2018 Reported: N/A Chemical Disclosure Registry Job End Date: 2/7/2018 Wellbore Date for Sidetrack #00 Spud Date: 6/26/2017 elibore Br it Permit #: Prop Depth/Form: 18627 Mineral Owner: FEE Unit: Formation and Spacing: Casing: Cement: Casing: Cement: Casing: Cement: eV ore C*m let Completion Date: Measured TD: True Vertical TD: Top PZ Location: Bottom Hole Location: Log Types: Casing: Cement: Casing: Cement: Casing: Cement: Formation PARKMAN SUSSEX SHANNON SHARON SPRINGS NIOBRARA FORT HAYS CODELL CARLILE Spud Date is: H ,`RIZ NTAL Expiration Date: Surface Mineral Owner Same: Surface Owner: Unit Number: Code: CODL , Formation: CODELL , Order: , Unit Acreage: 407, Drill Unit: GWA String Type: CONDUCTOR , Hole Size: 24, Size: 16, Top: 0, Depth: 40, Weight: 65 Sacks: 70, Top: 0, Bottom: 40, Method Grade: String Type: SURF , Hole Size: 13.5, Size: 9.625, Top: 0, Depth: 1700, Weight: 36 Sacks: 464, Top: 0, Bottom: 1700, Method Grade: String Type: 1ST , Hole Size: 8.5, Size: 5.5, Top: 0, Depth: 18627, Weight: 17 Sacks: 2277, Top: 0, Bottom: 18627, Method Grade: e Orders 7/1/2018 450687 NENE 32 6N66W 6 PM 4,706 ft Lat/Long Source: Field Measured Lat/Long Source: Field Measured Days to report: 10/1/2017 18626 7039 Sec: 32 Twp: 6N 66W Sec: 31 Twp: 6N 66W • Measured PB depth: True Vertical PB depth: Footage: 1900 FNL 85 FEL Footages: 1810 FNL 71 FWL Status: F .: 7/1/2018 ACTUAL 5/21/2019 9:25:24 AM FEE 18502 7041 Depth Depth MWD/LWD, CBL, Mud, (Pulsed Neutron on 123-44882). String Type: CONDUCTOR , Hole Size: 26, Size: 16, Top: 0, Depth: 40, Weight: 55 Sacks: 32, Top: 0, Bottom: 40, Method Grade: VISU String Type: SURF , Hole Size: 13.5, Size: 9.625, Top: 0, Depth: 1754, Weight: 36 Sacks: 715, Top: 0, Bottom: 1754, Method Grade: VISU String Type: 1ST , Hole Size: 8.5, Size: 5.5, Top: 0, Depth 18614, Weight: 20 Sacks: 2382, Top: 0, Bottom: 18507, Method Grade: CBL Log Top 3671 4170 4805 6916 6945 7440 8185 10503 Completed information for formation 1st Production Date: 6/1/2017 Status Date: 7/1/2018 Log ttorn M Choke Size: Open Hole Completion: Status: PR Cored N N N N N N N N 7/1/2018 STs N N N N N N N cogcc.state.co.us/data.html#/cogis 1/2 5/10/2019 COGIS - WELL Information Commingled: Production Method: Formation Name: NOT COMPLETED Status: Tubing Size: Tubing Setting Depth: Tubing Packer Depth: Tubing Multiple Packer: Open Hole Top: Open Hole Bottom: No Initial Test Data was found for formation N-COM No Perforation Data was found for formation N- COM. PR cogcc.state.co.us/data.html#/cogis 2/2 SHE nNERGY Dear Interest Owner, 1: ' r- 'e �. 14s -kid SEP `7 Lem 70171 ee•as CM) Mid ',Jfi to t'is, " . 4fr!•(j]UtdiU/yI" •, Y1 �i t 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.syrginfoocom FF 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): AG 5C -31C -L File Locations BY: LEO4 1 S LE0420 Bruce Ba er - County Attorney NOTES: .16 mineral acres/ 420.7 acres spa DATE: ing unit * 18°5% _ .0000703 MATCH NADOA Model Form Division Order (Adopted 9/95) DIVISION ORDER To: SRC ENERGY, Inc. 1675 Broadway, Suite 2600 Denver, CO 80202 Attention: Division Orders Date: September 20, 2018 Effective Date: 1St Production Property Number: AG5N-31 A -L Property Name: AG 5N -31A -L API p6- 12,3 ^ 414Oe Operator: SRC ENERGY INC County and State: Weld, Colorado Description: Township 6 North, Range 66 West Sec 31: S/2NE/4, SE/4NW/4, Sec 32: S/2N/2, Sec 33: SW/4NW/4 Containing 333.26 acres, more or less Production: X Oil X Gas X Other: all products Owner Name and Address: Owner Number: 3 883 Board of County Commissioners of the County Type of Interest: RI 1150 O Street PO Box 758 Decimal Interest: 0.00008882 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 ATTES CLE Tfi3O f BY: DEPUTY CLER Weld County Government 1150 "O" Street Greeley, CO 80634 Phone: 970-336-7204 Fax: 970-336-7233 Tax ID: 84-6000-813 Federal Law requires you to furnish your Social Security or Taxpayer Identification Number. Failure to comply will result in 28% tax withholding and will not be refundable by Payor db COv\SsL r loo & ct 5- 15- t') Retain this copy for your records S,eC /q- /r5 M LLDLt1q LC012O 333.26 See Tract Workin Int [OR NRI ORR Rev Int TOTAL 0.00000000 0.00008882 + 0.00000000 + 0.00000000 + OWNER INTEREST REPORT Well Group Ag wells Date Printed: 3/6/2019 OWNER NAME Weld County REPORT FOR WELLS BELOW Unit Name 33.14 Short (5N -31A -L) Total Acres in Spacing Unit (SU Acres) # of Tracts Owned in SU 2 Unit 6N -66W Sec 31: S2NE, SENW; Sec 32: 52N2; Sec 33: SWNW Desc Ag 5N -31A -L Owners TOTAL Interest in Each Well Owners Lease Royalty Interest OWNER INTEREST REPORT Well Group ag Date Printed: 10/26/2018 OWNER NAME Weld County Unit Desc _y.izc- = ellar lca- a"..`u<,7. 'S,ni✓tm4ig4m.AzIt'!..e. .-,: :ad,,7g' 4Naege aa.e� t'.%e#4,2 5gegitWA ?'kR`f4° e�xJ'tl's MPST 33.14 Short (5N -31A -L) alkrakg3Ua"di ftWk,4�P.il'«NfiCa11R;WaVXCSIYJlf1 'tkPMSWRNWfI.O',!W'/erfiaWfd t"W7"(fi'M'f70 t'+*:1'PWSNfa:. 6N -66W Sec 31: S2NE, SENW; Sec 32: S2N2; Sec 33: SWNW Oil True Gas True FM Desc CDNI SU Tracts in which Owner has an interest Tract ID 33.14 Short (5N -31A -L) 4 Sec Owners Lease Royalty Interest Mineral int. x Tract Acres Owners Over Riding Royalty Owner's Working Interest VVI 333.26; 32 trQQ swnw Tract Ac, Total Acres in Unit in Unit Mineral Acres 0.06000000 JIB Interest from Tract (ItTrFacto 0 0.06 ; 333.26 Mineral Int. Ise Rov Tr Factor 1 x 0.185 x 0.00018004 Tracts Proportion of Unit (Tr Factor) ORR 0.00000000 y 0.00018004 = NRIwi 0.00000000 y 0.00018004 = Total Rev Interest in SU from this Trac 0.000180 Rev Interest 0.00003331 0.00000000 0.00000000 Tract.itit rtiaon IWract D 33.14 Short (5N -31A -L) 42 Sec Owners,Lease Royalty Interest Mineral in. x Tract Acres Owners Over Riding Royalty Owner's Working Interest JIB Inter Est from Tract; ..�,.i .o,. ,,.4 rrx✓ F,o ., gyp... ;: i.:. ,, •4Ys 32 trc1i.. swnw Tract Ac. Total Acres in Unit in Unit Mineral Acres 0.10000000 0.1 •333.26 Tracts Proportion of Unit (Tr Factor) IV ineral lnt. Lse Rov Tr Factor 1 x 0.185: y 0.00030007 = 0.00000000: y 0.00030007 = N R lwi 0.00000000 x :0.00030007 = Total Rev st in SU from fi is Tract t.v�1 ..n' �i1 !v .vroJv4 �AY)y e..ne.,bin��j��VrgCcm�o.arvE'�?. U u,\, ,.4 M'Irvnxr Woclaia 0.000300 Rev Interest 0.00005551 0.00000000 0.00000000 Owners Interest in Spacing Unit 33.14 Short (5N -31A -L) Wells in Spacing Unit Ag 5 N -31A -L WI TOTAL 0.00000000 LOR NR 1 O R R 0.00008882 + 0.00000000 + 0.00000000 + Rev I nt TOTAL Page 6of8 5/10/2019 COGIS - WELL Information Scout Card Related insp. MIT Z Doc k COA Jr Weflbore eta Orders Surface Location Data for API # 5-123-44878 Status: Well Name/No: Operator: Status Date: FacilitylD: County: Field: Planned Location As Drilled Location Ag #5IJ-31,E-L (click well name for production) SRC ENERGY INC - 10311 7/1/2018 450688 WELD #123 Federal or State Lease #: LocationID: Location: WATTENBERG - #90750 Elevation: 1008 FNL 572 FEL Footages Not Available Lat/Long: 40A49155/-104.79446 Lat/Long: 40A49155/-104.79446 Job Date: 1/18/2018 Reported: N/A Chemical Disclosure Registry Job End Date: 1/27/2018 Wellbore Data for Sidetrack #00 Spud Date: 6/27/2017 eUUb. re Permit Permit #: Prop Depth/Form: Mineral Owner: Unit: Formation and Spacing: Casing: Cement: Casing: Cement: Casing: Cement: &rC m listed 7/1/2018 450687 NENE 32 6N66W 6 PM 4,706 ft. Lat/Long Source: Field Measured Lat/Long Source: Field Measured Days to report: Status: P 7/1/2018 Spud Date is: ACTUAL HORIZONTAL Expiration Date: 18386 Surface Mineral Owner Same: FEE Surface Owner: FEE Unit Number: Code: NBRR , Formation: NIOBRARA , Order: , Unit Acreage: 332, Drill Unit: GWA String Type: CONDUCTOR , Hole Size: 24, Size: 16, Top: 0, Depth: 40, Weight: 65 Sacks: 70, Top: 0, Bottom: 40, Method Grade: String Type: SURF , Hole Size: 13.5, Size: 9.625, Top: 0, Depth: 1700, Weight: 36 Sacks: 464, Top: 0, Bottom: 1700, Method Grade: String Type: 1ST , Hole Size: 8.5, Size: 5.5, Top: 0, Depth: 18386, Weight: 17 Sacks: 2242, Top: 0, Bottom: 18386, Method Grade: 5/21/2019 9:25:24 AM Completion Date: 10/12/2017 Measured TD: 16160 Measured PB depth: 16030 True Vertical TD: 6741 True Vertical PB depth: 6740 Top PZ Location: Sec: 32 Twp: 6N 66W Footage: 1984 FNL 86 FEL Depth Bottom Hole Location: Sec: 31 Twp: 6N 66W Footages: 1891 FNL 2267 FWL Depth Log Types: Casing: Cement: Casing: Cement: Casing: Cement: Formation Log Top Log ottom PARKMAN 3688 SUSSEX 4188 SHANNON 4815 SHARON SPRINGS 7069 NIOBRARA O B RARA 7150 Co -,., pleted information tor formation -C OM 1st Production Date: 6/1/2017 Status Date: 7/1/2018 Commingled: Formation Name: Tubing Size: Choke Size: Open Hole Completion: Production Method: NOT COMPLETED Status: Tubing Setting Depth: MWD/LWD, CBL, Mud, (Pulsed Neutron on 123-44882). String Type: CONDUCTOR , Hole Size: 26, Size: 16, Top 0, Depth: 40, Weight: 55 Sacks: 32, Top: 0, Bottom: 40, Method Grade: VISU String Type: SURF , Hole Size: 13.5, Size: 9.625, Top: 0, Depth: 1751, Weight: 36 Sacks: 715, Top: 0, Bottom: 1751, Method Grade: VISU String Type: 1ST , Hole Size: 8.5, Size: 5.5, Top: 0, Depth 16140, Weight: 20 Sacks: 2122, Top: 0, Bottom: 16036, Method Grade: CBL Cored DSTs N N N N N N N N N N Status: PR 7/1/2018 PR cogccostate.co.us/data.html#/cogis 1/2 5/10/2019 COGIS - WELL Information Tubing Packer Depth: Open Hole Top: No Initial Test Data was found for formation N-COM No Perforation Data was found for formation N- COM. Tubing Multiple Packer: Open Hole Bottom: cogcc.state.co.us/data.html#/cogis 2/2 SRC ENERGY Dear Interest Owner, rat; Ktr., n',�yly4 i� G SEP 2 7 2018 wr-21 rOUNTY dk Z r• v.g `n? R ,tea 8" a, ^ , a �,"`� r.ri t,"'°� 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 FFF\I�rjW Si- ',t TTOF,if , "-y '- q4A 3 , h , �. .��, ...�r. .�, � �.�. P f! VIA ,�� L,� ty.. ��_ i •� ' it i 4-'& - i,P 0 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): AG 5N -31A -L File Location(s): LE0419 20420 asp^eg BYo DATE: Bruct:,arker - County Attorney i c'eccam: C, NOTES: .16 mineral acres/ 333a26 acres spacing unit * 18.5% = .0000888 MATCH Hello