HomeMy WebLinkAbout20153018 NADOA Model Form Division Order (Adopted 9/95)
DIVISION ORDER
To: Great Western Oil & Gas Company, LLC Date: June 23, 2015
1801 Broadway, Suite 500
Denver, CO 80202
Attn: Caitlin McEwen
Property Number: W10976 Effective Date: First Sales
Property Name: KODAK NORTH FD 28-082HC Operator: GREAT WESTERN OPERATING CO LLC AP/ o'-�/� 3
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County and State: Weld, Colorado
Property Township_ 6 North, Range 67 West
Description: Section 26: NW
Production: X Oil X Gas X Other: all products
OWNER NAME AND ADDRESS: OWNER NUMBER: 1381
WELD COUNTY ATTN: BARB CONNOLLY TYPE OF INTEREST: RI
PO BOX 758 DECIMAL INTEREST: 0.00075502
GREELEY , CO 80632
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above
payable by Great Western Oil & Gas Company, LLC (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$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.
Special Clauses: ( ne o See Att hed Exhibit)
Owner(s) Signature(s): c_17 Barbara Kirkmeyer (�WELD COUNTY Commissioners Chair; , / J (off �'�
Owner(s) Tax I.D. Number(s): 84-6000-813 SEP 1 0 2015 Attest: .
970-336-7204 k to the Board
Owner Daytime Telephone
Owner FAX Telephone #: 970-336-7233 : � � • ���
Deputy Cl:rk to t e and
Owner Email Address 2015-3018 6,
•
Federal Law requires you to furnish �r•'r;�=' i•%� - : Taxpayer Identification Number.
Failure to comply will result in 31 %t. iV 1%d will not be refundable by Payor
CJM
I}y�Q �- (A� Ir 0 y��� ) Ret/7n this coDv for Tr cord L iC J D 3?J
9-,1,-i5 1E0.239
INSTRUCTIONS TO ALL INTEREST OWNERS
Dear Interest Owner,
Great Western Oil and Gas Company , LLC has enclosed a Division Order/Transfer Order for your execution .
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/Transfer Order.
2 . If your name has changed due to marriage or divorce , execute the Division Order/Transfer Order using
your present name and furnish a copy of the marriage certificate or divorce decree .
4 . If signing for a corporation , signature must be attested , corporate seal fixed and title of signatory party
reflected .
5 . If signed by 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 .
6 . Your correct mailing address should be noted in the space provided to insure prompt receipt of
production proceeds .
7 . The " Sign and Return Copy " of the Division Order/Transfer Order should be returned to :
Great Western Oil and Gas Company, LLC
1801 Broadway, Suite 500
Denver, CO 80202
Attn : Caitlin McEwen
8 . Should you have any further questions regarding the enclosed Division Order/Transfer Order, please
contact Caitlin McEwen at 303-398-0546 .
9 . Please DO NOT DETACH the exhibit from the Division Order/Transfer Order if one is included .
Great Western
Great Western Operating Company, LLC OIL & GAS COMPANY Phone : 303 .398.0546
1801 Broadway, Suite 500 Facsimile : 866 . 742. 1784
Denver, CO 80202 Email : OwnerRelations@gwogco . com
vvww . gwogco . com
June 24 , 2015
RE : KODAK NORTH FD 28-082HC KODAK NORTH FD 28- 1 19HN
T6N R67W TbN R67W
Sec . 26 : NW Sec . 26 : NW
Sec , 27 : N2 Sec , 27 : N2
Sec . 28 : E2NE Sec . 28 : E2NE
Weld County, CO Weld County, CO
Ladies and Gentlemen :
Great Western Operating Company , LLC is pleased to announce the captioned Kodak
wells have been completed as producing wells . First sales were June 10, 2015 .
Enclosed please find copies of the Division Order (s ) that pertain to your individual interest.
( Please note you may not have an interest under all wells . ) Please sign the documents
where indicated and complete the pertinent information before returning one ( 1 ) copy of
the Division Order, The duplicate copy may be retained for your records ,
Upon receipt of your executed Division Order, Great Western will place your interest in a
pay status . Royalty checks are processed every month and mailed mid-month .
* Please note that we have a $ 100 ,00 minimum suspense requirement; until such
time your interest accrues $ 100 .00 or more, the system will not generate a check for
payment .
If you have any questions or concerns regarding the enclosed documents , please do not
hesitate to contact me .
Best Regards,
GREAT WESTERN OPERATING COMPANY LLC
atter-
Caitlin McEwen
Division Order Analyst
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Great Western Operating Company, LLC March 3 , 2015
Page 21
Total 100.000000 %
Tract 4 - Leasehold Ownership :
Name WI RI LEASE
Fit
Grizzly Petroleum Company, LLC 100.000000% 80 .000000% A
Dynasty Royalty Company, LLC 5 .000000% (ORI) A
Town of Windsor, Colorado ------ 15 .000000% (LOR) A
Total 100.000000% 100.000000 %
Tract 5 : Section 27 : That portion of the following described parcel of land , lying in the
W/2NW/4 : A tract of land more particularly described in a Quit-Claim Deed dated
May 26, 1936 , recorded in Book 995 , Page 167 at Reception No. 741541 as follows :
That part of the W/2 of Section 27 , T6N , R67W , 6th P . M . , as follows : Commencing
at the NW corner of Sec . 27, Twp . 6 N . , R. 67 W ., thence 30 ft. E . on the N. line of
said Section to a point. Beginning at said point thence S . 0°09 ' W . parallel to the
W . line of Sec . 27 , Twp . 6 N. , R. 67 W . for a distance of 5277 . 5 ft. , more or less,
to a point on the S . Section line of said Section 30 ft. E . of the SW corner of said
Section ; thence E . on the S . Section line of said Section for a distance of 10 ft. ;
thence N . 0°09 ' E. parallel to the W . line of said Section for a distance of 5277 . 5
ft. , more or less, to a point on the N . Section line of said Section; thence W . on the
N . Section line of said Section for a distance of 10 ft. , more or less to a point, said
point being the beginning point; containing 1 .21 acres, more or less .
(Containing 0 .606 acres, +. )
Tract 5 - Surface Ownership :
Weld County, Colorado 100 . 000000%
Total 100.000000 %
Tract 5 - Oil and Gas Ownership : LENM
Weld County, Colorado 100. 000000%
Total 100.000000 %
Tract 5 - Leasehold Ownership:
Name WI NM LEASE
Grizzly Petroleum Company, LLC 100 .000000% 80.000000% B
Dynasty Royalty Company, LLC 7 .500000% (ORI) B
Weld County, Colorado ------ 12.500000% ( LOR) B
Total 1100.000000% 100.000000%
a
Great Western Operating Company, LLC March 3 , 2015
Page 25
Tract 9 - Leasehold Ownership : LED030
(As to all formations)
Na WI NRI LEASE
24Extraction Oil & Gas, LLC 100 .000000% 81 . 500000% RRRR
Weld County, Colorado 18 . 500000% (LOR ) RRRR
Total 100.000000% 100.000000%
Tract 10 : Section 28 : That part of Lot 1 , Block 1 of the Water Valley Subdivision 2"d Filing,
Phase 2 , also described as Weld County Assessor' s Parcel No . 080728109001 ,
lying in the E/2NE/4 of Section 28 .
(Containing 250 . 177 acres, ±)
Tract 10 — Apparent Surface Ownerslip :
Jennifer Kornfield 100. 000000%
Total 100.000000 %
Tract 10- Oil and Gas Ownership :
Jennifer Kornfield 100 .000000%
Total 100.000000 %
Tract 10 - Leasehold Ownership:
(As to all formations)
Name WI NRI LEASE
Extraction Oil & Gas, LLC 100 .000000% 81 . 750000% G
Viki J . Lind 0. 750000% ( ORI ) G
Affirm Energy, LLC 0 .500000% (ORI) G
Jennifer Kornfield 17 .000000% ( LOR) G
Total 100.000000% 100.000000%
24 Although the Lessee in Lease RRRR is stated to be "Extraction Oil and Gas," we believe the Lessee ' s actual name
to be "Extraction Oil & Gas, LLC ." See Comment/Requirement No. 26 .
25 We attribute 0. 177 acres, ± to that portion of Lot 1 tying in the E/2NE/4 of Section 28 and 0 .022 acres, + to that
portion lying in the W '2NE/4, for a total of 0 . 199 acres, ± .
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COGIS - WELL Information Page 1 of 1
COGIS - WELL Information
Scout Card n ® Related Us Insp . R MIT `= GIS a Doc 2). COA Wellbore aL Orders
Surface Location Data for API # 05- 123-39385 Status : DG 12/ 14/2014
Well Name/No : Kodak North FD #28-082HO (click well name for production )
Operator: GREAT WESTERN OPERATING COMPANY LLC - 10110
Status Date : 12/14/2014 8 : 00 : 00 AM Federal or State Lease #:
County : WELD # 123 Location : SENW 26 6N 67W 6 PM
Field : WATTENBERG - #90750 Elevation : 4 , 761 ft.
Planned Location 2252 FNL 1970 FWL Lat/Long : 40 .459011 /- 104 . 863283 Lat/Long Source : Field Measured
Job Date : 5/25/2015
Frác Focus Job End Date : 6/3/2015 Reported : 6/19/2015 Days to report : 16
Chemical Disclosure Registry
Wellbore Data for Sidetrack #00 Status : DG 12/ 14/2014
Spud Date : 12/14/2014 Spud Date is : NOTICE
Wellbore Permit HORIZONTAL
Permit #: Expiration Date : 5/2/2016 12 : 20 : 16 PM
Prop Depth/Form : 14230 Surface Mineral Owner Same :
Mineral Owner: FEE Surface Owner: FEE
Unit: Unit Number:
Formation and Spacing : Code : CODL , Formation : CODELL , Order: , Unit Acreage : 560 , Drill Unit: GWA
Casing : String Type : CONDUCTOR , Hole Size : 24 , Size : 16 , Top : 0 , Depth : 80 , Weight: 42
Cement: Sacks: 121 , Top : 0 , Bottom : 80 , Method Grade :
Casing : String Type : SURF , Hole Size : 13 . 5 , Size : 9 . 625 , Top : 0 , Depth : 1054 , Weight: 36
Cement: Sacks : 475 , Top : 0 , Bottom : 1068 , Method Grade :
Casing : String Type : 1ST , Hole Size : 7 . 875 , Size : 5 . 5 , Top : 0 , Depth : 15101 , Weight: 17
Cement: Sacks : 1625 , Top : 0 , Bottom : 15101 , Method Grade :
Casing : String Type : 1ST LINER , Hole Size : 6 . 125 , Size : 4 . 5 , Top : 6800 , Depth : 14231 , Weight : 11 .6
Cement: Sacks: 403 , Top : 6800 , Bottom : 14231 , Method Grade :
Wellbore Completed
Completion Date : N/A
Measured TD : Measured PB depth :
True Vertical TD : True Vertical PB depth :
Top PZ Location : Sec: 26 Twp : 6N 67W Footage : 1084 FNL 1825 FWL Depth
Bottom Hole Location : Sec: 28 Twp : 6N 67W Footages : 1084 FNL 300 FEL Depth
Formation Log Top Log Bottom Cored DSTs
No additional interval records were found for sidetrack 00 .
http : //cogcc . state . co . us/cogis/FacilityDetail . asp?facid= 12339385 &type=WELL 8/ 10/2015
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 ) : Kodak North FD 28 - 119HN File Location ( s ) : LE0239
Kodak North FD 28 - 082HC LE0330
6 % : DATE : 4 ?; f 1 ( �
Bruce Barker - County Attorney
NOTES : 1 . 876 mineral acres/ 560 acres spacing unit * 18 . 5 % = 0 . 00061975 ( LE0330)
0 . 606 mineral acres/ 560 acres spacing unit * 12 . 5 % = 0 . 00013527 ( LE0239 )
Add 0 . 0061975 and 0 . 00013527 = 0 . 075502 % = MATCH
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