HomeMy WebLinkAbout20151324.tiff C A R R / Z O
NADOA Model Form Division Order(Adopted 9/95)
Owner: WELD COUNTY COLORADO Date: 03/26/2015
Description: Gaffney 2-29-8-61 Effective Date: 03/01/2014
Complete Property Description Listed Below
Production: X Oil X Gas Other: p C \/ (�)
[Owner Name and Address R E C E I tr E D
WELD COUNTY COLORADO Owner Number: 047962
ATTN:CLERK TO THE BOARD Type Interest: Royalty Interest CC �J�.'
PO Box 758 APR 2 6 •
GREELEY,CO 80632 Decimal Interest: 0.00025208
Phone Number: 9703564000X4200 FAX Number: 9703520242 WELL) COLINTy
Property Description COMMISSION:—C `.
Property: 2888.01 Gaffnev_2-29-8-61
Operator: CARRIZO OIL&GAS, INC. Location: Weld,CO API 05 -123- 35575
Map Reference Information
Weld,CO US Township:008-N Range:061-W Section:29 Lot: Otr/Qtr:NW/4
The undersigned certifies the ownership of the decimal interest in production proceeds as described payable by(Payor):
Carrizo(Niobrara)LLC
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 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 under igned and Payor may have certain statutory rights
under the laws of the state in which the property is located.
Owner(s)Signature(s): x bara Kirkmeyer, Chair
MY112015 � �;` ;�
Owner(s)Tax I.D.Number(s). a —.111-71 - — -ties - �j•-� w� i_
C -r . the Boa
11.4Le./�y
Owner(s)Daytime Phone#: • 1 .- 1 l .. .�\ _ S . =1 /-
� • Deputy C1ek to the Board
5l
Owner(s)FAX Number: 970336-7233 = { 4
'
Complete Property Description Listed Below ', tna/Pt (Ks
Production: X Oil X Gas _Other: '�..�*- --r2 2015-1324(1)
Owner Name and Address
(.7/ r'Je [ t eral
Failure
Law to omly you to s result
furnish Social Security or Taxpayer t Identification Number.
Failure to comply will result in 28%tax pout and will not be refundable by Payor.
51-Pen /d C'a-u- L,E0&7(v c?
,—/2. -/a
Carrizo Oil & Gas,Inc.
500 Dallas Street, Suite 2300
Houston, Texas 77002
Attn: Division Order Department
Phone Number: 877-341-2699
Fax: 713-328-1035
Email: LandOssncrRd.itions a erzo.net
DIVISION ORDER INSTRUCTIONS FOR EXECUTION
Please return one executed original (Division Order) Instrument in accordance with the instructions set
forth below retaining one copy for your records.
Do NOT alter this document unless the proper documentation is provided supporting the alterations contained
therein. Said documentation must be filed of record in the county/parish(s) where the well is located.
SIGNATURE:
• Sign your name exactly as shown on Division Order. If your signature is different,legal documentation
supporting the name change is required. If this interest is owned jointly by two or more individuals,ALL
signatures are required unless documentation is provided verifying authorization of one individual to sign
on behalf of all parties.
• Signatures by Agents,Attorneys-in-Fact,Guardians, or Trustees must be verified by attaching a copy of
the recorded legal documentation evidencing of the rights vested in the signatory party.
• In the event of multiple trustees and/or executors,ALL signatures are required unless documentation is
provided verifying authorization of one individual to sign on behalf of all parties.
• Signatures for companies,corporations or partnerships must be executed by an authorized officer with the
name and title of the signatory party printed beneath the signature.
ADDRESS:
• If your address for revenue payments is different from that reflected on the enclosed documentation,
please note the correct revenue payment address on the Division Order by crossing through your old
address and writing in the new one.
TAXPAYER IDENTIFICATION OR SOCIAL SECURITY NUMBER:
• To avoid a 28% withholding tax penalty,as mandated by the Internal Revenue Code,a Taxpayer
Identification Number or Social security Number is REQUIRED.
SEE THE BACK OF THIS DOCUMENT FOR FREQUENTLY
ASKED QUESTIONS
FREQUENTLY ASKED QUESTIONS
What is a Division Order?
A Division Order is a directive signed by the royalty owner verifying the purchaser or operator of a well and the decimal
interest of production owned by the royalty owner. Also, it provides the owner's address and tax identification number
(TIN).
How do I transfer my interest in a property?
Interest may be transferred by a deed or,when appropriate, an assignment. The deed or assignment must be recorded in
the county where the property is located. Carrizo must receive a recorded copy of the deed or assignment before
changing our records and issuing Division Orders. You may want to have an attorney prepare these documents.
What happens if I change address or marital status?
Address changes must be received in writing. Please send changes to Carrizo Oil &Gas, Inc., Attn: Division Order
Department, 500 Dallas Street, Suite 2300, Houston, Texas 77002. Please include your name, old address,new address,
social security number and signature, and if you have been receiving revenue payments your six digit owner number
reflected at the bottom left hand corner of your check detail. Please send a copy of your marriage certificate to update
your name as a result of marriage or a divorce decree if your last name changed due to divorce.
What happens when the interest owner of a property dies?
After Carrizo is notified the deceased owner's revenue will be held in suspense pending receipt of the proper probate
documents and/or affidavit of death and heirship. Upon notifying Carrizo you will be sent a letter describing what must
be received to transfer the interest of the deceased owner to the appropriate parties and an Affidavit of Death and Heirship
form if necessary.
When are royalty payments suspended?
For your protection,payments are suspended upon a title dispute, assignment of interest, notice of death; transfer of
property, or in the event of no known address. Keeping your information current can prevent this inconvenience.
When will I be paid?
Payments will be made monthly to all owners with cumulative balances of$100 or more at the end of each month.
Balances less than $100.00 will be released in November of each year.
What do I do if my check is lost, stolen,or becomes outdated?
Please allow(10)business days for your check to arrive in the mail. If your check is lost, stolen or becomes outdated,
please call us at 877-341-2699.
Where can I research unclaimed funds?
Each state makes an effort to locate rightful owners of production revenues through publication,holding the funds until
the owner is found. To locate and collect unclaimed funds,please visit the National Association of Unclaimed Property
Administrators ("NAUPA")website at 2.
What type of annual statements will I receive from your company?
Royalty interest owners receiving more than $10.00 annually will receive an IRS form 1099. This summarizes
your total payments and tax withholdings for the previous year.
What state regulatory agency can I contact regarding my property?
TEXAS—Texas Railroad Commission Phone: 512-463-7200 website:
LOUISIANA—Louisiana Office of Conservation Phone: 225-342-4500 website:
COLORADO—Colorado Oil and Gas Conservation Commission Phone: 303-894-2100 website:
Karla Ford
From: Sonia Callahan [Sonia.Callahan@crzo.net]
Sent: Friday, April 17, 2015 1:03 PM
To: Karla Ford
Subject: RE: 2nd Request Weld County- Division Order- GAFFNEY 2-29-8-61
Attachments: COPY OF O&G LEASE (RECEPTION #3734219).pdf; LETTER SIZE COPY OF THE PLAT
FOR GAFFNEY 2-29-8-61.pdf; ASSIGMENT OF LEASES WITH RESERVATION OF ORR
(RECEPTION # 3745669).pdf; NEW DOs - NO CHANGE OF INTERESTS MADE.pdf
Karla,
Per your request attached to this email please find the following documents:
Copy of O&G lease (Reception # 374219) and Assignment of Leases with Reservation of Overriding
Royalty Interest. (Reception #3745669).
Letter size copy of the plat reflecting the complete spacing unit with Weld County's mineral interest
outline and highlighted related to the division order.
• The latest Title Opinion did not have your interest in it. See the below calculations.
Spud Dates and dates of First Production
WELL NAME 1ST PRODUCTION
GAFFNEY 2-29-8-61 11Yrr 3R2/2014
• CALCULATIONS
TRACT 3- LEASE 20-15
Tract Factor (TF): 1.21/960 = 0.001260417
Weld County's Mineral Interest: 100%
Royalty: 20%
NRI: 1*.20= 0.20000000
r
ROYALTY INTEREST: 0.20000000 * 0.00126042 = 0.00025208
TRACT 3- LEASE 20-16
Tract Factor (IF): 1.21/960= 0.001260417
Weld County's Mineral Interest: 100%
Royalty: 20%
NRI: 1*.20= 0.20000000
ROYALTY INTEREST: 0.20000000 * 0.00126042 = 0.00025208
I am also attaching new Divisions Orders per Division Order Analyst. The interest has not change.
Please let me know if you have any questions or need more information.
Thanks, Sonia
From: Karla Ford [mailto:kford(;co.weld.co.us]
Sent: Friday, February 13, 2015 7:39 AM
To: Sonia Callahan
Subject: RE: 2nd Request Weld County - Division Order
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TP: 1.21/960 = 0.301260417 TP: 1.21/960 = 0.001260417
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COGIS - WELL Information Page 1 of 1
COGIS - WELL Information
Scout Card D-6®Related QInsp. q_MIr O GIS a Doc a COA 11`Wellbore Orders
Surface Location Data for API#05-123-38575 Status: PR 5/14/2014
Well Name/No: Gaffney#2-29-8-61 (click well name for production)
Operator: CARRiZO NIOBRARA LLC-10439
Status Date: 5/14/2014 Federal or State Lease#:
County: WELD#123 Location: SWNW 29 8N 61W 6 PM
Field: WILDCAT -#99999 Elevation: 4,991 ft.
Planned Location 2164 FNL 443 FVL Lat/Long:40.6338/-104.23827 Lat/Long Source: Field Measured
Job
V-rre Focus Date: 2/23/2014
Job End Reported: 3/5/2014 Days to report: 9
Chemrcal Disclosure Re�istrY Date: 2/24/2014
Wellbore Data for Sidetrack #00 Status: PR 5/14/2014
Spud Date: 12/19/2013 Spud Date is: ACTUAL
Wellbore Permit HORIZONTAL
Permit#: Expiration Date: 12/1/2015 4:38:55 PM
Prop Depth/Form: 13973 Surface Mineral Owner Same:
Mineral Owner: FEE Surface Owner: FEE
Unit: Unit Number:
Formation and Spacing: Code: NBRR , Formation: NIOBRARA,Order: 535-420, Unit Acreage:960, Drill Unit:S.20:ALL,S.29:N/2
Casing: String Type:CONDUCTOR,Hole Size: 18,Size: 16,Top:0,Depth:70,Weight:64
Cement: Sacks: 10,Top:0,Bottom:70, Method Grade:
Casing: String Type: SURF, Hole Size: 12.25,Size:9.625,Top:0,Depth: 1400,Weight:36
Cement: Sacks: 534,Top: 0,Bottom: 1400,Method Grade:
Casing: String Type: 1ST, Hole Size:8.75,Size:7,Top:0,Depth:6511,Weight:23
Cement: Sacks:589,Top: , Bottom:6511,Method Grade:
Casing: String Type: 1ST LINER, Hole Size:6.125, Size:4.5,Top:6742,Depth: 13973.Weight: 11.6
Cement: Sacks: ,Top:,Bottom: ,Method Grade:
Wellbore Completed
Completion Date: N/A
Measured TD: Measured PB depth:
True Vertical TD: True Vertical PB depth:
Top PZ Location: Sec:29 Twp:9N 61W Footage:2363 FNL 300 FFWLL Depth
Bottom Hole Location: Sec:20 Twp:9N 61W Footages:300 FNL 300 FFWLL Depth
Formation Log Top Log Bottom Cored DSTs
Completed information for formation N-COM Status: PR 5/14/2014
1st Production Date: N/A Choke Size:
Status Date: 5/14/2014 Open Hole Completion:
Commingled: Production Method:
Formation Name: NOT COMPLETED Status: PR
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
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12338575&type=WELL 4/22/2015
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): Gaffney 2-29-8-61 File Location(s): LE0276-2
i
BY: I • .y q DATE:
,
Brad Yatabe - Assistant County Attorney
NOTES: 1.21 mineral acres/ 960acres spacing unit *20 % = .00252 MATCH
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