HomeMy WebLinkAbout20170135.tiffcusi SYNERGI
RESOURCES CORPORATION
Amended Division Order
Property Name: See Attached Exhibit A
Property No.: See Attached Exhibit A
Operator: Synergy Resources Corporation
County and State: Weld County, Colorado
Description: See Attached Exhibit A
Production: Oil: Y
Gas: Y
Synergy Resources Corporation
1625 Broadway, Suite 300
Denver, CO 80202
Date: December 27, 2016
Effective Date: See Attached Exhibit A
OWNER
AND
ADDRESS
OWNER NO.
INTEREST
INTEREST
NAME
TYPE
Weld
PO
1150
Greeley,
Box
County
758
O Street
CO
Board of Commissioners
80632
3031
See Attached
Exhibit
A
See Attached Exhibit
A
The undersigned certifies the ownership of their decimal interest in the production or proceeds as described above.
Synergy Resources Corporation 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.
Synergy Resources Corporation may accrue proceeds until the total amount equals $100.00, or pay annually whichever occurs first,
or as required by applicable state statutes.
The undersigned, or their authorized representative, shall notify Synergy Resources Corporation in writing of any change in
ownership, percent interest, or payment address. All such changes shall be effective the first day of the month following receipt of
such notice.
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 and 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.
SIGNAT
BOARD O
ATTEST'
CLER
BY:
DEPUTY CLERK
/zit/
THE BOARD
9 2017
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 you Social Security or "Taxpayer Identification Number.
Failure to comply will result in 28% tax withholding and will not be refundable by Payor.
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EXHIBIT "A"
to Division Order dated December 27, 2016
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Property Description
T4N, R68W Sec 2: W/2NW
T4N, R68W Sec 2: W/2NW
T4N, R68W Sec 2: NW
Property Name
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Avex 11-2D
Avex 12-2D
Avex 2A
Propery No.
AVE 11-2 D
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LANDOWNER ROYALTY ("LOW')
Weld County, Board of Commissioners
AVEX 11-2, AVEX 12-2
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Division Order Title Opinion
T4N, R68W Sec. 2: NW/4
Weld County, Colorado
TRACT 2
A. Surface (2.69± acres):
Page 5
October 10, 2013
Owner
Interest
Board of County Commissioners of the County of
Weld
100%
B. Mineral Interests and Royalty (oil, gas and associated hydrocarbons only):
Owner
Minerals
Royalty
BOGLs
Board of County Commissioners
of the County of Weld
100.000000%
N/A
Unleased
C.
D.
Overriding Royalty Interests:
None of record.
Leasehold Working Interests:
Owner
Working
Mineral
Lease
BOGLs
Interest
Interest
Burdens
Board of County
Commissioners of the County
of Weld
100%
100%
N/A
Unleased
IV. ENCUMBRANCES
A. Taxes:
See Comment and Requirement 2 below.
B Mortgages and Deeds of Trust:
See Exhibit "B" attached hereto and incorporated herein by this reference.
C. Easements and Rights of Way:
See Exhibit "C" attached hereto and incorporated herein by this reference.
D. Unreleased Oil and Gas Leases:
(00561593.1} 5
WELD COUNTY SMALL -TRACT OIL AND GAS LEASE
Containing 2.693 acres, more or less:
Containing 2.893 net mineral acres, more or less:
THIS LEASE AGREEMENT, dated this 17th day of December , 20 13 , made and entered into
by and between WELD COUNTY, COLORADO, a political subdivision of the STATE OF COLORADO,
acting by and through the BOARD OF COUNTY COMMISSIONERS OF THE COUNTY OF WELD, for its
respective Interests, do BOARD OF COUNTY COMMISSIONERS, 1150 O STREET, P.O. BOX 758,
GREELEY, CO 80632, hereinafter called Lessor, and:
Synergy Resources Corporation, a Colorado Corporation,
20203 Highway 60, Platteville, Colorado 80651
hereinafter called Lessee:
WITNESSETH
WHEREAS, said Lessee has applied to Lessor for an oil and gas lease covering the land herein
described, and has paid a bonus consideration of $ $800 per mineral acre, fixed by Lessor as
an additional consideration for the granting of this lease, and Lessee agrees to pay an annual rental of
$ 6.73 , computed at the rate of $2.50. per mineral acre or fraction thereof per year, and the
following consideration:
WHEREAS, all the requirements relative to said application have been duly complied with and said
application has been approved and allowed by Lessor;
THEREFORE, In consideration of the agreements herein, on the part of Lessee to be paid, kept and
performed, Lessor does lease exclusively to Lessee for the sole and only purpose of drilling for,
development of and production of oil and gas, or either of them, thereon and therefrom with the right to
own all oil and gas so produced and saved therefrom and not reserved as royalty by Lessor under the
terms of this lease, together with rights -of -way, easements and servitudes for pipelines, telephone and
telegraph lines, tanks and fixtures for producing and caring for such product, and housing and boarding
employees, and any and all rights and privileges necessary for the exploration and operation of said land
for oil and gas, the following described land situated in the County of Weld, State of Colorado, and more
particularly described as follows:
SECTION TOWNSHIP RANGE
2 4N 68W
DESCRIPTION OF LAND (attach exhibit If additional space is required)
SEE EXHIBIT "A"
TO HAVE AND TO HOLD said land, and all the rights and privileges granted hereunder to Lessee
until the hour of twelve o'clock noon on the 18th day of December , 20 16 , as primary term, and so
long thereafter as oil and gas, or either of them, is produced in paying quantities from said land or Lessee
is diligently engaged in bona fide drilling or reworking operations on said land, subject to the terms and
M CTB'LOIL & GASU.EASE FORMS\FOLease_Smalfrract2013.docx
(Revised 09/2013)
2014-1045
4010178 Pages: 1 of 14
04/18/2014 01:03 PM R Fee:$0.00
Stave Moreno. Clerk and Recorder, Weld County. CO
1111 llr1�'�14t��t+�1 �i 1L'14,4;i1W?i t 110 1141 U) III
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AREA ALLOCATION
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AREA ALLOCATION TABLE
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VIA EMAIL AND U.S. MAIL
September 9, 2013
Ms. Sue Eich
Manager of Land
Synergy Resources Corporation
20203 Highway 60
Platteville, CO 80651
Re: Division Order Title Opinion
Avex 11-2D (W/2NW/4 targeting the Codell formation)
Avex 12-2D (W/2NW/4 targeting the Codell formation)
Avex 21-2D (E/2NW/4 targeting the Coder1/Niobrara formations)
Avex 22-2D (E/2NW/4 targeting the Codell formation)
Avex 2A (NW/4 targeting the Codell formation)
Our File No. 06511.0106 (Avex DOTO)
Township 4 North, Range 68 West, 6th P.M.
Section 2: NW/4
Weld County, Colorado
containing 141.38± acres ("the Lands")1
Dear Ms. Eich:
I. Materials Examined
DUFFORD
BROWN
ATTORNEYS AT LAW
snonnaduf ordbrown.com
A. DRILLING TITLE OPINION ("August 2012 Prior Opinion") dated August 31, 2012,
prepared by Randall J. Feuerstein, of Dufford & Brown, P.C., covering the NW/4 of
Section 2, Township 4 North, Range 68 West, 6th P.M., containing 138.68 acres, more or
less, to March 24, 2010 at 7:00 a.m.
B. Property Index Searches provided by Heritage Title Company of Greeley at the request of
Synergy Resources Corporation and provided to us by Mike J. Shotwell, Petroleum Land
Consultant, agent for Synergy Resources Corporation, covering the Lands identifying
documents recorded from March 24, 2010 at 7:00 a.m. through April 30, 2013 at 7:00
a.m. ("DMS").
C. Copies of Documents as highlighted by Mike Shotwell on the above DMS report.
I See Area Allocation plat prepared by Alles Taylor & Duke, LLC, dated August 13, 2013, Job #2013-067, attached
hereto and incorporated herein by this reference as Appendix "A".
1700 Broadway / Suite 2100 / Denver, CO 80290-2101 / Phone 303.861.8013 / Fax 303.832.3804 / www.dufforcibrown.com
{00550500.1}
COGIS - WELL Information
Page 1 of 2
Well Name/No:
Operator:
Status Date:
County:
Field:
Planned Location
As Drilled Location
Frac Focus
Chemical Disclosure Registry
Wellbore Data for Sidetrack #00
9/25/2012
COGIS - WELL Information
Scout Card Doe Related Q Insp. Q MIT • GIS a Doc Ill COA if Wellbore
Surface Location Data for API # 05-123-35223 Status: PR
Avex #11-2D (click well name for production)
SYNERGY RESOURCES CORPORATION - 10311
2/20/2013
WELD #123
WATTENBERG - #90750
1060 FNL 1570 FWL
Footages Not Available
Job Date:
Job End Date
Spud Date:
Wellbore Permit
Permit #:
Prop Depth/Form: 8234
Mineral Owner: FEE
Unit:
Formation and Spacing:
Formation and Spacing:
Casing:
Cement:
Casing:
Cement:
Wellbore Completed
Completion Date: 9/30/2012
Measured TD: 7872 Measured PB depth: 7806
True Vertical TD: 7775 True Vertical PB depth: 7709
Top PZ Location: Sec: 2 Twp: 4N 68W Footage: 557 FNL 604 FWL Depth
Bottom Hole Location: Sec: 2 Twp: 4N 68W Footages: 550 FNL 585 FWL Depth
Log Types: CBL HRI/CD/CN
Casing: String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 585, Weight: 24
Cement: Sacks: 175, Top: 0, Bottom: 585, Method Grade: CALC
Casing: String Type: 1ST , Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 7860, Weight: 11.6
Cement: Sacks: 765, Top: 1550, Bottom: 7860, Method Grade: CBL
1/28/2013
1/28/2013
Federal or State Lease #:
Location:
Elevation:
Lat/Long: 40.346256/-104.974628
Lat/Long. 40.346258/-104.974628
a Orders
2/20/2013
NENW 2 4N68W 6 PM
5,004 ft.
Lat/Long Source: Field Measured
Lat/Long Source: Field Measured
Reported: 3/15/2013 Days to report 46
Formation
PARKMAN
SUSSEX
SHANNON
NIOBRARA
CODELL
J SAND
Status: PR 2/20/2013
Spud Date is: ACTUAL
DIRECTIONAL
Expiration Date: 3/5/2014 10:58:32 PM
Surface Mineral Owner Same: Y
Surface Owner: FEE
Unit Number:
Code: JSND , Formation: J SAND , Order: 232-23 , Unit Acreage: 320, Drill Unit: W/2
Code: NB -CD , Formation: NIOBRARA-CODELL , Order: 407-87 , Unit Acreage: 80, Drill Unit: W/2 NW/4
String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 550, Weight: 24
Sacks: 350, Top: 0, Bottom: 550, Method Grade:
String Type: 1ST , Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 8234, Weight: 11.6
Sacks: 410, Top: 200, Bottom: 8234, Method Grade:
Log Top
3454
3960
4516
6926
7260
7720
Log Bottom Cored
Completed information for formation CODL Status: PR 2/20/2013
1st Production Date: 2/20/2013 Choke Size:
Status Date: 2/20/2013 Open Hole Completion: N
Commingled: N Production Method:
Formation Name: CODELL Status: PR
Formation Treatment Treatment Type: FRACTURE STIMULATION
Treatment Date: 1/28/2013 Treatment End Date: 1/28/2013
Treatment summary: Silverstim Frac on the Codell with a total of 114,912 gal of FR66 water, 175,080 lbs of 30/50 Ottawa sand, 1,804 gal of WG-
18.
Total fluid used in treatment (bbls): 2736 Max pressure during treatment (psi): 3509
Total gas used in treatment (mcf): 0 Fluid density (lbs/gal): 1
Type of gas: Number of staged intervals: 9
Total acid used in treatment (bbls): 0 Min frac gradient (psi/ft): 0.79
Recycled water used in treatment (bbls): 0 Total flowback volume recovered (bbls): 912
Produced water used in treatment (bbls): 2736 Disposition method for flowback: DISPOSAL
Total proppant used (Ibs): 175080 Green completions techniques utilized: True
Reason green techniques not utilized:
Tubing Size: 2.375 Tubing Setting Depth: 7247
Tubing Packer Depth: Tubing Multiple Packer:
Open Hole Top Open Hole Bottom.
DSTs
http://cogcc.state.co.us/cogis/Facility Detail.asp?facid=12335223&type=WELL 12/30/2016
COGIS - WELL Information Page 2 of 2
Initial Test Data:
Test Date:
Hours Tested:
Gas Disposal:
Test Type
BBLS_OIL
BTU_GAS
CALC_BBLS_OIL
CALC_GOR
CALC_MCF_GAS
CASING_PRESS
GRAVITY_OIL
MCF_GAS
TUBING_PRESS
Perforation Data:
Interval Bottom:
# of Holes:
2/20/2013
24
SOLD
7279
72
Measure
223
1283
223
340
76
1000
44
76
1220
Test Method:
Gas Type:
Interval Top:
Hole Size:
flowing
WET
7261
4
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12335223&type=WELL 12/30/2016
COGIS - WELL Information
Page 1 of 2
Total proppant used (lbs):
Reason green techniques not utilized:
Tubing Size:
Tubing Packer Depth:
Open Hole Top:
COGIS - WELL Information
Scout Card 54 Related Q insp. Q MIT I GIS El Doc ai COA if Wellbore
Surface Location Data for API # 05-123-35221
Well Name/No:
Operator:
Status Date:
County:
Field:
Planned Location
As Drilled Location
Frac Focus
Chemical Disclosure Registry
Wellbore Data for Sidetrack #00
Avex #12-2D
Status: PR
(click well name for production)
SYNERGY RESOURCES CORPORATION - 10311
2/20/2013 Federal or State Lease #:
WELD #123 Location:
WATTENBERG - #90750 Elevation:
1120 FNL 1563 FWL Lat/Long: 40.346091/-104.974631
Footages Not Available Lat/Long: 40.346094/-104.97463
Job Date: 1/25/2013
Job End Date: 1/25/2013
Spud Date:
Wellbore Permit
Permit #:
Prop Depth/Form:
Mineral Owner:
Unit:
Formation and Spacing:
Formation and Spacing:
Casing:
Cement:
Casing:
Cement:
Wellbore Completed
Completion Date:
Measured TD:
True Vertical TD:
Top PZ Location:
Bottom Hole Location:
Log Types:
Casing:
Cement:
Casing:
Cement:
Reported: 3/15/2013
Status: PR
10/10/2012 Spud Date is:
DIRECTIONAL
Expiration Date:
8227 Surface Mineral Owner Same:
FEE Surface Owner:
Unit Number:
Code: JSND , Formation: J SAND , Order: 232-23 , Unit Acreage: 320, Drill Unit: W/2
Code: NB -CD , Formation: NIOBRARA-CODELL , Order: 407-87 , Unit Acreage: 80, Drill
String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 550, Weight: 24
Sacks: 350, Top: 0, Bottom: 550, Method Grade:
String Type: 1ST , Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 8227, Weight: 11.6
Sacks: 410, Top: 200, Bottom: 8227, Method Grade:
10/16/2012
7858 Measured PB depth: 7856
7756 True Vertical PB depth: 7754
Sec: 2 Twp: 4N 68W Footage: 1807 FNL 691 FM.. Depth
Sec: 2 Twp: 4N 68W Footages: 1848 FNL 625 FWL Depth
CBL HRI/CD/CN
String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 605, Weight: 24
Sacks: 175, Top: 0, Bottom: 605, Method Grade: CALC
String Type: 1ST , Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 7847, Weight: 11.6
Sacks: 775, Top: 560, Bottom: 7847, Method Grade: CBL
Formation
SUSSEX
SHANNON
NIOBRARA
FORT HAYS
CODELL
J SAND
Log Top
4009
4520
6928
7231
7254
7713
Completed information for formation CODL
1st Production Date:
Status Date:
Commingled:
Formation Name:
Formation Treatment
Treatment Date:
2/20/2013
2/20/2013
N
CODELL
a Orders
2/20/2013
NENW 2 4N68W 6 PM
5,003 ft.
Lat/Long Source: Field Measured
Lat/Long Source: Field Measured
Days to report: 49
2/20/2013
ACTUAL
3/5/2014 10:58:32 PM
Y
FEE
Unit: W/2 NW/4
Log Bottom Cored
Status: PR 2/20/2013
Choke Size:
Open Hole Completion:
Production Method:
Status:
Treatment Type:
1/25/2013 Treatment End Date:
Treatment summary: Frac on the Codell with a total of 206,135 gal of FR66 water, 157,750 lbs of 30/50 Ottawa
sand.
Total fluid used in treatment (bbls): 4908
Total gas used in treatment (mcf): 0
Type of gas:
Total acid used in treatment (bbls): 0
Recycled water used in treatment (bbls): 0
Produced water used in treatment (bbls): 4908
170250
2.375
Max pressure during treatment (psi):
Fluid density (lbs/gal):
Number of staged intervals:
Min frac gradient (psi/ft):
Total flowback volume recovered (bbls):
Disposition method for flowback:
Green completions techniques utilized:
Tubing Setting Depth:
Tubing Multiple Packer:
Open Hole Bottom:
N
PR
FRACTURE STIMULATION
1/25/2013
sand, 12,500 of 40/70 Ottawa
5095
1.25
9
0.77
1636
DISPOSAL
True
7149
DSTs
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12335221 &type=WELL
12/30/2016
COGIS - WELL Information Page 2 of 2
Initial Test Data:
Test Date:
Hours Tested:
Gas Disposal:
Test Type
BBLS_OIL
BTU_GAS
CALC_BBLS_OIL
CALC_GOR
CALC_MCF_GAS
CASING_PRESS
GRAVITY_OIL
MCF_GAS
TUBING_PRESS
Perforation Data:
Interval Bottom:
# of Holes:
2/20/2013
24
SOLD
7273
72
Measure
123
1354
123
723
89
900
44
89
1100
Test Method:
Gas Type:
Interval Top:
Hole Size:
flowing
WET
7255
0.38
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12335221 &type=WELL 12/30/2016
COGIS - WELL Information
Page 1 of 2
COGIS - WELL Information
Scout Card Related v insp. Q MIT • GIS a Doc a COA '9C` Wellbore
Surface Location Data for API # 05-123-35222
Well Name/No:
Operator:
Status Date:
County:
Field:
Planned Location
As Drilled Location Footages Not Available
Frac Focus
Chemical Disclosure Registry
Wellbore Data for Sidetrack #00 Status: PR 2/20/2013
Spud Date: 10/5/2012 Spud Date is: ACTUAL
Wellbore Permit
Permit #: Expiration Date: 3/5/2014 10:58:32 PM
Prop Depth/Form: 8120 Surface Mineral Owner Same: Y
Mineral Owner: FEE Surface Owner: FEE
Unit: Unit Number:
Formation and Spacing: Code: JSND , Formation: J SAND , Order: 232-23 , Unit Acreage: 320, Drill Unit: W/2
Formation and Spacing: Code: NB -CD , Formation: NIOBRARA-CODELL , Order: , Unit Acreage: 160, Drill Unit: NW/4
Casing: String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 550, Weight: 24
Cement: Sacks: 350, Top: 0, Bottom: 550, Method Grade:
Casing: String Type: 1ST , Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 8120, Weight: 11.6
Cement: Sacks: 410, Top: 200, Bottom: 8120, Method Grade:
Wellbore Completed
Completion Date: 10/11/2012
Measured TD: 7760 Measured PB depth: 7708
True Vertical TD: True Vertical PB depth:
Log Types: CBL HRI/CD/CN
Casing: String Type: SURF , Hole Size: 12.25, Size: 8.625, Top: 0, Depth: 605, Weight: 24
Cement: Sacks: 175, Top: 0, Bottom: 605, Method Grade: CALC
Casing: String Type: 1ST , Hole Size: 7.875, Size: 4.5, Top: 0, Depth: 7760, Weight: 11.6
Cement: Sacks: 735, Top: 1335, Bottom: 7760, Method Grade: CBL
Formation Log Top Log Bottom Cored DSTs
SUSSEX 3397
SHANNON 4462
TEEPEE BUTTES 6016
NIOBRARA 6838
CODELL 7160
J SAND 7618
Completed information for formation CODL Status: PR 2/20/2013
Status: PR
Avex #2A (click well name for production)
SYNERGY RESOURCES CORPORATION - 10311
2/20/2013 Federal or State Lease #:
WELD #123 Location:
WATTENBERG - #90750 Elevation:
1099 FNL 1566 FWL Lat/Long: 40.346147/-104.97463
Lat/Long: 40.346148/-104.974629
a. Orders
2/20/2013
NENW 2 4N68W 6 PM
5,003 ft.
Lat/Long Source: Field Measured
Lat/Long Source: Field Measured
Reported: 3/15/2013 Days to report: 46
1st Production Date:
Status Date:
Commingled:
Formation Name:
Formation Treatment
Treatment Date:
Job Date: 1/28/2013
Job End Date: 1/28/2013
2/20/2013
2/20/2013
N
CODELL
1/28/2013
Choke Size:
Open Hole Completion:
Production Method:
Status:
Treatment Type:
Treatment End Date:
N
PR
FRACTURE STIMULATION
1/28/2013
Treatment summary: Silverstim Frac on the Codell with a total of 111,888 gal of FR66 water, 175,000 lbs of 30/50 Ottawa sand, and 2,074 gal
of WG-18.
Total fluid used in treatment (bbls): 2664 Max pressure during treatment (psi): 4324
Total gas used in treatment (mcf): 0 Fluid density (lbs/gal): 1.4
Type of gas: Number of staged intervals: 9
Total acid used in treatment (bbls): 0 Min frac gradient (psi/ft): 0.78
Recycled water used in treatment (bbls): 0 Total flowback volume recovered (bbls): 888
Produced water used in treatment (bbls): 2664 Disposition method for flowback: DISPOSAL
Total proppant used (lbs): 175000 Green completions techniques utilized: True
Reason green techniques not utilized:
Tubing Size: 2.25 Tubing Setting Depth: 7149
Tubing Packer Depth: Tubing Multiple Packer:
Open Hole Top: Open Hole Bottom:
http://cogcc.state.co.t.ts/cogis/FacilityDetail.asp :'facid=12335222&type=WELL 12/30/2016
COGIS - WELL Information Page 2 of 2
Initial Test Data:
Test Date:
Hours Tested:
Gas Disposal:
Test Type
BBLS_OIL
BTU_GAS
CALC_BBLS_OIL
CALC_GOR
CALC_MCF_GAS
CASING_PRESS
MCF_GAS
TUBING_PRESS
Perforation Data:
Interval Bottom:
# of Holes:
2/20/2013
24
SOLD
7178
72
Measure
70
1281
70
600
42
1000
42
1200
Test Method:
Gas Type:
Interval Top:
Hole Size:
flowing
WET
7160
4
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12335222&type=WELL 12/30/2016
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):
AVEX 11-2D
AVEX 12-2D
AVEX 2A
Bruce Barker - County Attorney
DATE:
File Location(s): LE0323
3
NOTES: 2.69 mineral acres/ 141.38 acres spacing unit * 25% = .00475669 MATCH
December 12, 2016
Dear Interest Owner,
SYNERGY
RESOURCES CORPORATION
1625 Broadway, Suite 300
Denver, CO 80202
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 Synergy Resources Corporation 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:
Synergy Resources Corporation
1625 Broadway, Suite 300
Denver, CO 80202
8. Should you have any further questions regarding the enclosed Division Order, please contact
Macy Mullins (720)-616-4324 mmullins@syrginfo.com or Synergy Resources Corporation at
720-616-4300.
Sincerely,
Macy Mullins
Division Order Analyst
Synergy Resources Corporation
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