HomeMy WebLinkAbout20151325.tiff NADOA Model Form Division Order (Adopted 9/95)
DIVISION ORDER
To: Great Western Oil & Gas Company, LLC Date: February 9, 2015
1801 Broadway, Suite 500
Denver, CO 80202
Attn: Caitlin McEwen ,11
AM 05- 12.3 - 1154
Property Number: W11959 Effective Date: January 1, 2015
Property Name: Hal
Operator: GREAT WESTERN OPERATING CO LLC C a f"i:-e ".
ms, e - i N
County and State: Weld, Colorado
Property Township 6 North, Range 67 West
Description: Secti : NESE
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: 0.00007810
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 or See At ached Exhibit)
Owner(s) Signature(s): Barbara Kirkmeyer, Chair
WELD COUNT MAY 1 1 1015 �
Owner(s) Tax I.D. Number(s): 84-6000-813 p a Attest: � '�^ "�
Cle to the Board
Owner Daytime Telephone 970-336-7204 �I1
Owner FAX Telephone #: 970-336-7233 •
'� _ Deputy Cl rk to the Board
Owner Email Address bkirkme er@wel. •.
A,,
DAIL
Federal Law requires you to furnish your\cgcr w fjYtit or Taxpayer Identification Number.
Failure to comply will result in 31 % tax wit and will not be refundable by Payor
CJM / 5 '
Ck Re ain s copy for your records 3 o j//,j
5-I1--15 ia- is" LE0C5`cI
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
OPERATING COMPANY.LIC
Mineral Lease Map
Haas 1
Township 6 North, Range 67 West, 6th P.M.
Section 15 (NESE)
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Legend
Weld County Lease
Well Spacing Unit
Great Western
Great Western Operating Company, LLC OILS. GAS COMPANY Phone: 303.398.0546
1801 Broadway,Suite 500 Facsimile: 866.742.1784
Denver, CO 80202 Email: OwnerRelations@gwogco.com
www.gwogco.com
February 9, 2015
RE: Haas 1 RECEIVED
T6N R67W 2
Sec. 15: NESE
Weld County, Co C 1015
O ELDMAR COUNTY
MMISSIONERS
Ladies and Gentlemen:
The purpose of this letter is to inform you that Great Western Oil & Gas Company (GWOC)
acquired Bill Barrett Corporation's (BBC) working interest under the Haas 1 well. Effective
January 1, 2015, GWOC took over as c pe atoe and will now be distributing 100% of the
production revenue associated with this well. The enclosed division orders are based on the
ownership deck BBC was using prior to their divestiture of interest.
Enclosed please find copies of the Division Order(s) that pertain to your individual interest.
Please sign the documents where indicated and complete the pertinent information before
returning one (1) copy of the Division Order to our office in the enclosed envelope. 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
Caitlin McEwen
Division Order Analyst
2015-1325
Enc
LEO05�
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): Haas 1 File Location(s): LE0059
BY: l .1t-r !t_ T DATE: 4 f� J
5
Brad Yatabe - Assistant County Attorney
NOTES: There was already a division order in place - but Great Western is now the operators. The royalty
interests show the same.
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