HomeMy WebLinkAbout20181570.tiffNADOA Model Form Division Order (Adopted 9/95)
REVISED DIVISION ORDER
To: PDC Energy, Inc Date:
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Joshua Schumacher (303) 318-6178 or Joshua.Schumacher@pdce.com
Property Number:
Property Name: Klein 19N-302 NB
Operator: PDC Energy, Inc
County and State: Weld, Colorado
Property Township 5 North, Range 64 West
105.101335
April 24, 2018
Effective Date: March 31, 2017
API* OS-la3 -'b10145
Description: Section 19: SWNE (Spacing - Sec 19: NE; Sec 20: N2; Sec 21: NW, W2NE - 728.4904 acres)
Production: X
Oil X
Gas X
Other: all products
Owner Name
and Address:
Weld County Board of Commissioner
OWNER NUMBER: 43444
Type of Interest:
Decimal Interest:
RIS / RI
0.00009409 / 0.00500978
In partial suspense pending completion of Requirement # 26
i _
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC
Energy, Inc. (Payor).
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 $50.00, or pay yearly 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.
Special Clauses:
SIGNATURE:
BOARD OF
ATTEST:
CLER `t`; E BOARD
BY:
DEPUTY CLERK T
Owner Email Address:
E J COUNTY
.
(None or See Attached Exhibit)
72/
MMI, ION :RS,C
HE BOARD
Weld County Government
1150 "O" Street
Greeley, CO 80634
one: 970-336-7204
x: 970-336-7233
x I D : 84-6000-813
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 24% tax withholding and will not be refundable by Payor
2018-1570 1,
I
LMH
eon&WAqec&t SWIMS'
Retain this copy for yojjr records
LEmBio, LEMffl
1.-E03KS, [E039
Exhibit A
105 101335 - Klein 19N-302 NB
Owner No
Credit To Type Interest
43444 Weld County Board of Comm
(0 3705*100%/728 4904`18 5%) =
43444 Weld County Board of Comm
Interest
RIS 0 00009409 «Your Interest
(0 285*100%/728 4904*18 5%)+(0 0918*100%/728 4904*18 5%)+(3 60
89*100%/728 4904*18 5%)+(0 4348*100%/728 4904*18 5%)+(0 5612*1
00%/728 4904*18 5%)+(0 767*100%/728 4904*18 5%)+(0 4864*100°/0/7
28 4904*18 5%)+(0 3743*100%/728 4904*18 5%)+(0 5799*100%/728 4
904*18 5%)+(4 6503*100%/728 4904*18 5%)+(2 9713*100%/728 4904*
18 5%)+(0 5612*100%/728 4904*18 5%)+(0 5612*100°/0/728 4904*18 5
%)+(0 1871 *100%/728 4904*18 5%)+(0 7859*100%/728 4904*18 5%)+(
0 1871 *100%/728 4904*18 5%)+(1 4033*100%/728 4904*18 5%)+(0 91
36*100%/728 4904*18 5%)+(0 3171 *100%/728 4904*18 5%) = RI 0 00500978 « Your
Amanda Petzold
From:
Sent:
To:
Subject:
Attachments:
Amanda,
Joshua Schumacher <Joshua.Schumacher@pdce.com>
Tuesday, May 08, 2018 11:56 AM
Amanda Petzold
RE: [EXTERNAL] :Amanda W/ Weld County
Klein req. 26.docx
The .00000002 at the end of the division order is used to correct the rounding discrepancy between the excel
spreadsheet that we receive title on and the system that we used to house all out data. This minor difference will cause
no difference in the amount of royalties paid out over the life of a well.
As for the RI/RIS, this indicates that a portion of the interest is currently held in title suspense. Please see the attached
document for the Comment/ Requirement. Once this requirement has been satisfied, the proceeds will be able to be
release.
Thanks,
Joshua Schumacher] Division Order Analyst II
61PDC Energy, Inc. 11775 Sherman Street, Suite 3000, Denver, CO 80203
Direct Dial: 303-318-6178 I Main: 303-860-5800 I Fax 303-860-5838 I Email:Joshua.Schumacher@pdce.com
This email, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. Please do not
read, copy or disseminate this communication unless you are the intended addressee. If you received this communication in error, please permanently delete and call 1-303-860-
5800 immediately and ask to speak to the sender of this communication. Also, please notify immediately via e-mail that you have received this message in error.
From: Amanda Petzold [mailto:apetzold@weldgov.com]
Sent: Tuesday, May 8, 2018 11:56 AM
To: Joshua Schumacher <Joshua.Schumacher@pdce.com>
Subject: [EXTERNAL] :Amanda WI Weld County
Please Note: My normal working hours are Tuesdays -Thursdays.
Amanda Petzold
Deputy Clerk to the Board
1150 O Street / P.O. Box 758
Greeley, CO 80631
tel: (970) 400-4224
1
REOUIREMENT No 26- (Joint Tenancy S5rccessron of Benito Archuleta and Juanita M Archuleta rn Tracts
25G-2, 25G--4, 25G-5, 25G-1 and .25G-9 Herein) The prior Drilling and Division Order Title Opinion dated July
24.2014 revised March 17. 2015, prepared by Jeffrey Stengel on behalf of Carleton Gothu Law P_C P.C. included
the following Comment/Requirement No 71 regarding joint tenancy succession of Benito Archuleta and Juanita
M Archuleta in Tracts 25G-2, 25G-4, 25G-5. 25O- 8 and 25G-9 herein
"At one point in the chain of title. Benito Archuleta and Juanita M Archuleta, as joint tenants,
owned 100% of the surface and inenerals in Lots 5, 6, 11-14 and 25-29 all in Block 7, Town of
Kersey Subdivision [portions of Tracts 25G-2, 25G-4, 25G-5, 25O-8 and 25G -9j Subsequently.
by Warranty Deed, dated September 14. 1949, recorded at Reception No 1097914 on January 4,
1951, Juanita Archuleta conveyed to Ehgio Vigil and Maria Vigil, all right title and interest in
said lands There was nothing in the materials examined, including a review of the EagleWeb
system, indicating that the interest of Benito Archuleta, owner in joint tenancy with Juanita
Archuleta, was transferred to Juanita Archuleta_ either by his death prior to the date of the above
Warranty Deed or by an actual conveyance
For 'imposes of this Opinion, subject to the Requirement below, the examiner presume:, that
Juanita Archuleta properly succeeded to the interest of Benito Archuleta, either by conveyance or
the death of her joint tenant, Benito Archuleta, prior to the execution of this Warranty Deed The
remainder of the chain of title for [portions of Tracts 25G -2.25G-4, 25G-5, 25G-8 and 25G-91
stems from Juanita Archuleta In addition, the examiner notes that the mineral interests in [Tracts
25G-2, 25G-- 25G-5, 25G-8 and 25G-91 are currently unleased-"
Mr Stengel then advised that, "PDC Energy, Inc_ should verify the examiner's presumption that Juanita Archuleta
succeeded to the entire interest she owned', in Tracts 25G-2, 25G-4, 25O-5, 25G-8 and 25G-9, "previously with
Benito Archuleta in joint tenancy Evidence of this succession must be recorded in the records of Weld County,
Colorado " Nothing in the materials ex -untried indicates that this requirement has been satisfied_ Tracts 25G-2,
25G -f, 25G-5, 25G-8 and 25G-9 are currently covered by Oil and Gas Leases 71, 73, 74, 17 and 75, respectively
Requirement A Certificate of Death far Benito Archuleta along with an Affidavit of
Survivorship should be recorded in Weld County, Colorado The Affidavit of Survivorship should
be executed by a person having personal knowledge of the fact; but no personal interest in the
property and should include the legal description of the real property and a statement that the
person referred to in the recorded Certificate of Death was at the time of death the owner of a
joint tenancy real property interest
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): Klein 19N-302
File Location(s): LE03�b, LE0387, LE0388, LE0391
BY: �`/ � - . DATE: ;---1q((T
Bruce Barker - County Attorney
NOTES: 19.7274 mineral acres/ 728.4904 acres spacing unit * 18.5% = 0.00500978 MATCH (RI)
0.3705 mineral acres/ 728.4904 acres spacing unit * 18.5% = 0.00009409 MATCH (RIS)
*Bruce, please see the back-up email correspondence communicating the RIS interest.
NADOA Model Form Division Order (Adopted 9/95)
REVISED DIVISION ORDER
To: PDC Energy, Inc
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Joshua Schumacher (303) 318-6178 or Joshua.Schumacher@pdce.com
Date: April 25, 2018
Property Number: 105.101284 & 105.104.283 Effective Date: March 13, 2017 & March 8, 2017
Property Name: le Klein 19M-232 NB & Klein 19M-402
Operator: PDC Energy, Inc
County and State: Weld, Colorado
Property Township 5 North, Range 64 West
Description: Section 19: NWNE ( Spaced Section 16: S2SW, SWSE; Section 17: S2S2: Section 18: S2SE; Section 19: N2NE;
Section 20: N2N2; Section 21: N2NW, NWNE ) — 725.0147 acres
Production: X
Oil X
�. P itits A3 a 4/00150
a. AST. X05- ia.3-4od'Ib
Gas X
Other: all products
Owner Name
and Address:
Weld County Board of Comm
PO Box 758
Greeley, CO 80632-0758
OWNER NUMBER: 43444
Type of Interest: RI
Decimal Interest: 0.003905 83
i
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC
Energy, Inc. (Payor).
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 $50.00, or pay yearly 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.
Special Clauses: (None or See Attached E
SIGNATURE:
BOARD OF �[
ATTEST' �
CLER • T`E BI
BY:
DEPUTY CLERK T,
TH BOARD
Owner Email Address:
Weld County Government
1150 "O" Street
Greeley, CO 80634
Phone: 970-336-7204
Fax: 970-336-7233
Tax I n • R4 -F 000-R 1 R
dog- 070 (2)
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 24% tax withholding and will not be refundable by Payor
JMS
ccaeznius .Acrac\
Retain this copy for your records
LEo3gto LE.oss1,
LE63SfB
Exhibit A
105 101284 & 105 101283 - Klein 19M-232 NB & Klein 19M-402
Owner No
Credit To Type Interest
43444 Weld County Board of Comm
+(0 5612/725 014699999999*100%*18 5%)
+(0 767/725 014699999999*100%*18 5%)
+(0 4864/725 014699999999*100°/0*18 5%)
+(0 3743/725 014699999999*100%*18 5%)
+(0 5799/725 014699999999*100%*18 5%)
+(4 6503/725 014699999999*100%*18 5%)
+(2 9713/725 014699999999*100%*18 5%)
+(0 5612/725 014699999999*100%*18 5%)
+(0 5612/725 014699999999*100%*18 5%)
+(0 1871/725 014699999999*100%*18 5%)
+(0 7859/725 014699999999*100%*18 5%)
+(0 1871/725 014699999999*100%*18 5%)
+(1 4033/725 014699999999*100%*18 5%)
+(0 9136/725 014699999999*100%*18 5%)
+(0 3171/725 014699999999*100%*18 5%)+ 00000002 = RI 0 00390583 «Your Interest
Amanda Petzold
From:
Sent:
To:
Subject:
Attachments:
Amanda,
Joshua Schumacher <Joshua.Schumacher@pdce.com>
Tuesday, May 08, 2018 11:56 AM
Amanda Petzold
RE: [EXTERNAL] :Amanda W/ Weld County
Klein req. 26.docx
The .00000002 at the end of the division order is used to correct the rounding discrepancy between the excel
spreadsheet that we receive title on and the system that we used to house all out data. This minor difference will cause
no difference in the amount of royalties paid out over the life of a well.
As for the RI/RIS, this indicates that a portion of the interest is currently held in title suspense. Please see the attached
document for the Comment/ Requirement. Once this requirement has been satisfied, the proceeds will be able to be
release.
Thanks,
Joshua Schumacher Division Order Analyst II
' PDC Energy, Inc. 11775 Sherman Street, Suite 3000, Denver, CO 80203
Direct Dial: 303-318-6178 I Main: 303-860-5800 I Fax 303-860-5838 I Email:Joshua.Schumacher@pdce.com
This email, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. Please do not
read, copy or disseminate this communication unless you are the intended addressee. If you received this communication in error, please permanently delete and call 1-303-860-
5800 immediately and ask to speak to the sender of this communication. Also, please notify immediately via e-mail that you have received this message in error.
From: Amanda Petzold [mailto:apetzold@weldgov.com]
Sent: Tuesday, May 8, 2018 11:56 AM
To: Joshua Schumacher <Joshua.Schumacher@pdce.com>
Subject: [EXTERNAL] :Amanda WI Weld County
Please Note: My normal working hours are Tuesdays -Thursdays.
Amanda Petzold
Deputy Clerk to the Board
1150 O Street / P.O. Box 758
Greeley, CO 80631
tel: (970) 400-4224
1,,a,.� Is
F
1
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): Klein 19M-232, Klein 19M-402
File Location(s): LE0386, LE0387, LE0388,
BY:
Bruce Barker - County Attorney
DATE:
clik(
NOTES: 15.3069 mineral acres/ 725.014699999999 acres spacing unit * 18.5% = 0.00390583 MATCH
NADOA Model Form Division Order (Adopted 9/95)
REVISED DIVISION ORDER
To: PDC Energy, Inc
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Joshua Schumacher (303) 318-6178 or Joshua.Schumacher@pdce.com
Property Number: 105.101285
Property Name: Klein 19N-31? NB
Operator: PDC Energy, Inc
County and State: Weld, Colorado
Property Township 5 North, Range 64 West
Date: April 24, 2018
Effective Date: March 18, 2017
API4*c- a3-qoaM1
Description: Section 19: NWNE (Spacing - Sec 19: N2NE; Sec 20: N2N2; Sec 21: N2NW, NWNE - 364.1947 acres)
Production: X
Oil X
Gas X
Other: all products
Owner Name
and Address:
Weld County Board of Comm
PO Box 758
Greeley, CO 80632-0758
OWNER NUMBER: 43444
Type of Interest: RI
Decimal Interest: 0.00777542
i _
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC
Energy, Inc. (Payor).
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 $50.00, or pay yearly 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.
Special Clauses: (None or See Attached Exhibi
SIGNATURE: Sajz--
BOARD OFV1rOSIOINERS, CH
ATf E S � ��C.
CLE' Tai HE BO
BY:
DEPUTY CLER f O T E BOAR
Owner Email Address:
Weld County Government
1150 "O" Street
Greeley, CO 80634
Phone: 970-336-7204
Fax: 970-336-7233
Tax ID: 84-6000-813
aoi14.,s7o
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 24% tax withholding and will not be refundable by Payor
LMH
1oci5etYr A9tth 'I1y1;S
R tain this copy for your records
it ?oP&
/9- - a
LEAmpi LEO3iscs,
t.s o381
Exhibit A
105 101285 - Klein 19N-312 NB
Owner No
Credit To Type Interest
43444 Weld County Board of Comm
(0 5612*100%/364 1947*18 5%)+(0 767*100%/364 1947*18 5%)+(0 48
64*100%/364 1947*18 5%)+(0 3743*100%/364 1947*18 5%)+(0 5799*1
00%/364 1947*18 5%)+(4 6503*100%/364 1947*18 5%)+(2 9713*100%/
364 1947*18 5%)+(0 5612*100%/364 1947*18 5%)+(0 5612*100%/364
1947*18 5%)+(0 1871 *100%/364 1947*18 5%)+(0 7859*100`)/0/364 1947
*18 5%)+(0 1871 *100%/364 1947*18 5%)+(1 4033*100%/364 1947*18
5%)+(0 9136*100%/364 1947*18 5%)+(0 3171 *100%/364 1947*18 5%) = RI 0 00777542 «
Your Interest
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): Klein 19N-312
File Location(s): LEO386, LEO387, LEO388
BY:
I
Bruce Barker - County Attorney
DATE:
(g'
NOTES: 15.3069 mineral acres/ 364.1947 acres spacing unit * 18.5% = 0.00777542 MATCH
NADOA Model Form Division Order (Adopted 9/95)
REVISED DIVISION ORDER
To: PDC Energy, Inc
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Joshua Schumacher (303) 318-6178 or Joshua.Schumacher@pdce.com
Property Number: 105.101337, 105.101338, 105.101339
Property Name: 1. Klein 19O-212, Klein 190-3023 Klein 19O-402
Operator: PDC Energy, Inc
County and State: Weld, Colorado
Property Township 5 North, Range 64 West
Description: Section 19: SWNE( Spaced: Sec. 19: S2NE, N2SE, Sec. 20: S2N2, N2S2, Sec. 21: S2NW, SWNE, NWSE)
—720.9637 acres
Date: April 26, 2018
Effective Date: 3/1/17, 2/27/17, 2/24/17
�- Ap 1. #oro- ! a3--y01l•ff
Z •4c, a 05- 0-3-'1•10151
3. AP s.. 4-CF0-t•3rL011-1tP
Production:
X
Oil
X
Gas
X
Other: all products
Owner Name
and Address:
Weld County Board of Comm
PO Box 758
Greeley, CO 80632-0758
OWNER NUMBER: 43444
Type of Interest: RI
Decimal Interest: 0.00122938
1
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC
Energy, Inc. (Payor).
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 $50.00, or pay yearly 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.
Special Clauses:
SIGNATURE:
(None or See Attached Exhibit)
nceteev..erf
BOARD OF V' f� C��TY�M`��,�,�IQ�RS, CH
ATTEST � r�<�
DEPUTY CLERK
Owner Email Address:
JMS
erctzc* Arlaa Mi'-t tI.O% Retain this copy for your records LEQ3ei/er
eld County Government
0 "O" Street
ley, CO 80634
970-336-7204
70-336-7233
84-6000-813
ozo Ano (4)
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 24% tax withholding and will not be refundable by Payor
211
i
Exhibit A
105 101337, 105 101338, 105 101339 - Klein 190-212, Klein 190-302, Klein 190-402
Owner No
Credit To Type Interest
43444 Weld County Board of Comm
+(0 285/720 963699999999*100%*18 5%)
+(0 3705/720 963699999999*100%*18 5%)
+(0 0918/720 963699999999*100%*18 5%)
+(3 6089/720 963699999999*100°/0*18 5%)
+(0 4348/720 963699999999*100%*18 5%) =
RI 0 00122938 «Your Interest
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): Klein 19N-312
File Location(s): LEO3 91
BY:
Bruce darker - County Attorney
DATE: 5/g'1/41
NOTES: 4.791 mineral acres/ 720.9636999999 acres spacing unit * 18.5% = 0.00122938 MATCH
NADOA Model Form Division Order (Adopted 9/95)
REVISED DIVISION ORDER
To: PDC Energy, Inc Date:
1775 Sherman Street, Suite 3000
Denver, CO 80203
Attn: Joshua Schumacher (303) 318-6178 or Joshua.Schumacher@pdce.com
Property Number: 105.101336
Property Name: Klein 19N-432 CD
Operator: PDC Energy, Inc
County and State: Weld, Colorado
Property Township 5 North, Range 64 West
April 24, 2018
Effective Date: April 4, 2017
A ft. * O5a\at1O1SQ
Description: Section 19: SWNE (Spacing - Sec 19: NE; Sec 20: NW, S2NE; Sec 21: S2NW, SWNE - 527.5457 acres)
Production: X Oil
X
Gas
X
Other: all products
Owner Name
and Address:
Weld County Board of Comm
PO Box 758
Greeley, CO 80632-0758
OWNER NUMBER: 43444
Type of Interest: RI
Decimal Interest: 0.00168011
i
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC
Energy, Inc. (Payor).
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 $50.00, or pay yearly 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.
Special Clauses: A (None or See Attached Exhibit)
SIGNATURE:
BOARD OF jj4)
TO�SjERS, CH
ATTEST �Ga.
CLE
BY:
DEPUTY CLER.#OT E BO
Owner Email Address:
LMH
&fltec* Ar�\ I Nlamg
Weld County Government
1150 "0" Street
Greeley, CO 80634
Phone: 970-336-7204
ax: 970-336-7233
Tax ID: 84-6000-813
020/-/510 (a)
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 24% tax wijhholdin an will not be refundable by Payor
Retain this (dopy for your records
LE 031 t
Exhibit A
105 101336 - Klein 19N-432 CD
Owner No
Credit To Type Interest
43444 Weld County Board of Comm
(0 285"100%/527 5457"18 5%)+(0 3705*100%/527 5457*18 5%)+(0 09
18*100%/527 5457*18 5%)+(3 6089*100%/527 5457*18 5%)+(0 4348*1
00%/527 5457*18 5%) = RI 0 001 6801 1 «Your Interest
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): Klein 19N-432
File Location(s): LEO391
BY:/ DATE: ��i ( )
Bruce Barker - County Attorney
NOTES: 4.791 mineral acres/ 527.5457 acres spacing unit * 18.5% = 0.00168011 MATCH
Hello