HomeMy WebLinkAbout20152078.tiff RETAI N
ExTRAtc11°N
NADOA Model Farm Dlvkkrn Order(Adapted 9/951—
DIVISION ORDER
To: Extraction Oil and Gas,LLC May 2015
1888 Sherman Street,Suite 200 RECEIVED
Denver,Colorado 80203
Well/Property Name:HINER 36C-24W MAY 18 2015
Well API Number.05-123-37044
Well/Property Number: 136 A_ 1 0 5'123-?j7� WELD COUNTY
County and State:WELD,CO COMMISSIONERS
Well Spacing Location:T6N R66W SEC 36:S2N2,N2S2
Spacing Unit Gross Acres: 320.00
Production Type:_X Oil X Gas Other:
Owner Number Owner Name Tax Identification Interest Type Interest Decimal
12105 WELD COUNTY CO BOARD OF XXX-XX-0813 RI 0.00120828
COUNTY COMMISSIONERS
1150 O STREET
GREELEY,CO 80632 _
The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by
Extraction Oil and Gas,LLC("Payor").
Payor shall be notified,in writing,of any change in ownership,decimal interest,or payment address. All such changes shall
be effective within 60 days of notification from Payee.
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.
A facsimile or scanned copy of a signed copy of this Division Order shall be deemed an original.
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number. I
Signatt ves Wi ses: cif er(s)Signature: Owner(s)Tax I.D.(SSN or EIN):
Attes 84-6000-813
Clerk to the Board Barbara Kirkmeyer, C air
County Board of
�P /O,^��'1 ommissioners
... . `� Phone Number(optional):
Deputy Cl ,, •}' r N
k01lir74 %.,* � •O Email Address(optional):
J 2015-2078()
,6 1603,45"
ysr
HAI
HAI
cat CCH
up IV
m O
N
O
U L▪ in \
H r-{ U
CO
L0011
\\
in co)
m
lm O D N D
a \
N O
U m
CCH
CO
it tut:
Ln
Ln O
N O
ri
O \
U
It m U
CCH
It: N.: :::
in
cN—I + , \ N
00 E \ N
O \
N O \
m p p
r._ O I
03 i Ln
►— \ Nk
O O o \
N \ in
\ N
oo \ � \ � \
N E \ O C \ N
\ o _
c6 N \ U Ln
\ p ' N
\ -1 �--+ '0 00
it
U R3 H H ri U Q N
It: \ ro
H \ NO O
C.
\ O .
I u, \ �cn in \ o �n \ oNo
Lo
N \ m orNi
in +� �n ni +� Ln mLn \ o
in O \ p VD N D O M O D \� p
N o \ o , O \\\ o , o \ o
o \Lc) o 0 O \ o 4 o \ co\ O +� m \ m U rn \ o
L `� *'k u Lip
(13 \ O H U \ !� I- N U
L \\ gco \ o u \ g
o`no it � H oo
O o \ ri
ni
v \ QJ \\\\\\\ \ win
cd \ 00
U \ Z CO
U
N o \ 2 Q o \ 2 O
c z o \ a- z o \ z o
O \ o 3 4-, N o
up `n Z m ,,, \ M 1D z m v, \ >- N M v,
tY, Cr;Lip \ 00 co Z to m a� �D L m ctt° O ' U
M lU C C C L \ ' co C .E O \ O M lD c _ O U
Z _ ID Z U •U C O \.: Z Z U 4-1 C O O Z Z U O
_ �— vi c%i U � _ vii U 2 Imo— cn U
P
Karla Ford
From: Jocelyn Bice < JBice@extractionog .com >
Sent: Friday, June 19, 2O15 11 :04 AM
To: Karla Ford
Subject: RE: Weld County Division Orders
Hi Karla,
You can determine which lease goes with which DO by the spacing described in each . If the spacing described
in the lease falls within the spacing of that well , they go together.
Example :
Lease # 1806310
A strip of land 100 feet in width over and acres the SW 1 /4 , Section 25 , Township 6 North, Range 66 West of
the 6th P . M .
The HIDER 36C - 17W is the only well that matches this description. Therefore this lease belongs with this
well .
N
The following are the Weld County Leases with their associated wells . ( 17= Hiner 36C - 17W, etc)
Lease Rec #
1806310- 17LE039q ,-
(_,p • g L�,C�n
3914564- 17, 18 -23 LEO31 3 5L-t azis°
0. 54 01C/11'93908202- 17 , 18 -23 LE 03l q
4024029- 24LEO3S
o GLvi
4024028 - 17 � � ED .4Rs, fl aoup
u '• � g
4085077- 17 1,9 3 5 Co
4085078 - 17 W035 .-7 is
1
COGIS - WELL Information Page 1 of 1
COGIS - WELL Information
Scout Card b` ` , T Related Q. Insp . Ct MIT GIS a Doc a COA ljt VVeflbore .y' Orders
Surface Location Data for API # 05- 123-37044 Status : PR 5/ 12/2015
Well Name/No : HINER #360-24W (click well name for production )
Operator: EXTRACTION OIL & GAS LLC - 10459
Status Date : 5/12/2015 Federal or State Lease #:
• County : WELD #123 Location : NENE 36 6N 66W 6 PM
Field : WATTENBERG - #90750 Elevation : 4 , 661 ft.
P lanned Location 1044 FNL 901 FEL Lat/Long : 40 .449146/-104 . 719084 Lat/Long Source : Field Measured
As Drilled Location Footages Not Available Lat/Long : 40 . 44914/- 104 . 719081 Lat/Long Source : Field Measured
Frié Focus Job Date : 9/23/2014 Job End Date . 9/29/2014 Reported : 11 /4/2014 Days to report: 36
Chemical Disclosure Registry
•
Wellbore Data for Sidetrack #00 Status : PR 5/ 12/2015
Spud Date : 8/11 /2014 Spud Date is : ACTUAL
Wellbore Permit HORIZONTAL
Permit #: Expiration Date : 3/19/2015 5 : 08 : 13 PM
Prop Depth/Form : 7361 Surface Mineral Owner Same : Y
Mineral Owner: FEE Surface Owner: FEE
U nit: Unit Number:
Formation and Spacing : Code : CODL , Formation : CODELL , Order: , Unit Acreage : 320 , Drill Unit: GWA
Formation and Spacing : Code : NBRR , Formation : NIOBRARA , Order: 381 - 17 , Unit Acreage : 160 , Drill Unit: NE/4
Casing : String Type : SURF , Hole Size : 13 . 5 , Size : 9 . 625 , Top : 0 , Depth : 1200 , Weight: 36
Cement: Sacks : 655 , Top : 0 , Bottom : 1200 , Method Grade :
Casing : String Type : 1ST , Hole Size : 8 . 75 , Size : 5 . 5 , Top : 0 , Depth : 12096 , Weight: 20
Cement: Sacks : 1990 , Top : 0 , Bottom : 12096 , Method Grade :
Casing : String Type : 1ST LINER , Hole Size : 6 . 125 , Size : 4 . 5 , Top : 7500 , Depth : 11972 , Weight: 13. 5
Cement: Sacks : 0 , Top : 0 , 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: 36 Twp : 6N 66W Footage : 2648 FNL 460 FEL Depth
Bottom Hole Location : Sec: 36 Twp : 6N 66W Footages : 2677 FNL 460 FWL Depth
Formation Log Top Log Bottom Cored DSTs
Completed information for formation N -COM Status : PR 5/ 12/2015
1st Production Date : N/A Choke Size :
Status Date : 5/12/2015 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 :
N o Initial Test Data was found for formation
N-COM .
N o Perforation Data was found for formation
N-COM .
http : //cogcc . state . co . us/cogis/FacilityDetail . asp ?facid= 12337044&type=WELL 6/25 /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 ) : Hiner 36C - 24W File Location ( s ) : LE0325
BY : 04 „ DATE : C6 Z7*6
Brad Yat - Assistant County Attorney
NOTES : 2 . 09 mineral acres/ 320 . 0 acres spacing unit * 18 . 5 % = . 00120828 MATCH
EXT ON
INSTRUCTIONS TO ALL INTEREST OWNERS
YOU ARE RECEIVING THIS PAPERWORK BECAUSE EXTRA, r IS CURRENTLY PRODUCING OIL
AND(OR OM A NEW YOU HAYS . `, D► AS AN INTEREST
OWNER .ORDER TO RECEIVE YOUR ROYALTY PAYMENT 3 W PAPERWORK MUST BE SIGNED
AND RETURNED.THIS IS NOT AIN Or FER TO PURCHASE OR E YOUR miNERAL, RIGHTS.
EXTRACTION OIL AND GAS LLC. (`EXTRACTION')HAS ENCLOSED A DIVISION ORDER FOR YOUR
EXECUTION. PLEASE REVIEW,AND EXECUTE ONE COPY TO BE RETURNED TO OUR OFFICES,AND ONE
COPY FOR YOUR RECORDS.
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.
2. Have your signature witnessed by two competent witnesses.A notary is not required.
3. 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.
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. Division Orders for partnerships must be executed by all partners or by an
authorized partner. A certified copy of the instrument giving said partners authority to sign must be
furnished.
7. Federal law requires that you furnish a correct social security or taxpayer identification number. Failure to comply
will result in 28%tax withholding required by the Internal Revenue Service and will not be refunded by Extraction.
You may also be subject to a further penalty levied by the Internal Revenue Service.The enclosed W-9 form must be
completed and returned with your division order.If your tax identification number is pre-printed on the division order,a W-9
form is not required.
8. If the Division Order or Exhibit contains an incorrect mailing address,your correct mailing address should be noted on the
exhibit to insure prompt receipt of production proceeds. Please print or type the correct mailing address using no
abbreviations.
9. The"Return"portion should be returned to:
•JOCelyfriMp
10. Should you have any further questions regarding the enclosed Oil Division Order,
please contact Jocelyn Bice at jbice@extractionog.com
11. Please DO NOT DETACH the exhibit from the Division Order if one is included.
12. Please visit our website at ExtractionOG.com to learn more about Extraction Oil and Gas.
EXTRACTION OIL AND GAS,LLC,1888 SHERMAN ST,SUITE 200,DENVER,CO 80203-PHONE 720-557-8300
EXTRpCTION
Royalty Interest Calculation Symmary
Your currently interest type can be found on the division order,in the box labeled interest type.
Royalty Interest (RI)
Your interest is calculated by taking the net acres you own, dividing it by the total number of acres that
are contained within the spacing of the well(this can be found on the front of the division order), and then
multiplying it by your lease royalty.
Example: Property ABC South 1st Street which is owned by Joe D. Smith contains 0.95 net acres.
Joe D. Smith signed a lease with Company XYX for a 10%royalty.
The said well producing from property ABC contains a total of 500 gross acres.
0.95 net acres=500 gross acres x .10(or 10%lease royalty)=
0.019% or 0.00019 decimal interest owned by Joe D.Smith
Force Pooled Royalty Interest (FPRI)
Your interest is currently unleased and has been force pooled per the Colorado Commissions
Statutes. The statue requires that an operator pays a 12.5%royalty interest until payout. The calculations are
done the same as above,however the statutory 12.5%royalty is used.
Example: Property ABC South 1st Street which is owned by Joe D. Smith contains 0.95 net acres.
The said well producing from property ABC contains a total of 500 gross acres.
Joe D. Smith is unleased, so 12.5%royalty is used.
0.95 net acres-500 gross acres x .125 (or 12.5%statute royalty) =
0.02375% or 0.0002375 decimal interest owned by Joe D. Smith
*If your mineral rights are unleased and you are interested in leasing them. please contact
our Land Department at Land(ii ExtractionOG.com.
EXTRACTION OIL AND GAS,LLC,1888 SHERMAN ST,SUITE 200,DENVER,CO 80203-PHONE 720-557-8300
Hello