HomeMy WebLinkAbout20151789.tiff NADOA Model Form Division Order (Adopted 9/95)
DIVISION ORDER
To: Great Western Oil 8. Gas Company, LLC Date: May 18,2015
1801 Broadway, Suite 500
Denver, CO 80202
Attn: Caitlin McEwen
Property Number: W11959 Effective Date: January 1, 2015
Property Name: HAAS 1
Operator: GREAT WESTERN OPERATING CO LLC
County and State: Weld, Colorado APB o5-1a3 — 1150
Property Township 6 North, Ranae 67 West
Description: Section 15: 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: 0.00009375
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$100.00, or pay annually whichever occurs first, or as
required by applicable state statute.
This Division Order does not amend any lease or operating agreement between the undersigned and the
lessee or operator or any other contracts for the purchase of oil or gas.
In addition to the terms and conditions of this Division Order, the undersigned and Payor may have certain
statutory rights under the laws of the state in which the property is located.
Special Clauses: ( one or See At ached Exhibit)
Owner(s) Signature(s): �,�,/
ELD COUNT B0CC Chair ATTEST: �,dZljn/ 6: ��1LO;
Owner(s) Tax ID. Number(s): 84 6000-813 JUN 1 7 2015 WELD " U TY CLERK TOTH. q1$. . ) ate`
Owner Daytime Telephone 970-336-7204 BY:
Owner FAX Telephone #: 970-336-7233 DEPUTY C 1 RK TO THE
Owner Email Address bkirkmeyer@weldgovi com
Federal Law requires you to furnish your Social Security or Taxpayer Identification Numb '�-'
Failure to comply will result in 31 %tax withholding J and will not be refundable by Payor
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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 Gil c GAS COMPANY Phone: 303.398.0546
1801 Broadway,Suite 500 facsimile: 866.742.1784
Denver,CO 80202 Email: OwnerRelations@gwogco.com
www.gwogco.com
May 18, 2015
RE: Haas 1
T6N R67W
Sec. 15: NESE
Weld County, CO
Ladies and Gentlemen:
Great Western Oil & Gas Company (GWOC) is pleased to announce it acquired Bill Barrett
Corporation's (BBC) working interest under the Haas 1 well. Effective January 1, 2015,
GWOC took over as operator and will now be distributing 100% of the production revenue
associated with this well. The enclosed division orders are based on new Title.
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
Enc
LE0b5e7
Karla Ford
From: Caitlin McEwen [cmcewen@gwogco.com]
Sent: Monday, June 01, 2015 8:55 AM
To: Karla Ford
Subject: RE: Haas 1 Well
Sorry for the delayed reply.
The calculations are as follows:
Mineral interest Lease Royalty Tract Acres Unit Acres
Total LOR
Weld County 100% 15% 0.1
160 (0.15*0.1)/160 = 0.00009375
Please let me know if you need anything else.
Thank you,
Caitlin McEwen
11,y....
Division Order Analyst
Great Western Operating Company, LLC
1801 Broadway, Suite 500
Denver, CO 80202
Direct: 303.398.0546
Fax: 866.742.1784
Privileged/Confidential information may be contained in this message. This information is intended solely for
use by the individual entity named as the recipient. If you are not the intended recipient, be aware that any
disclosure, copying distribution, or use of the contents of this communication is prohibited. In such case, you
should destroy this communication and notify the sender by reply email.
t
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: Cl I a + ) DATE: ry (() ZG J
Brad Yata'e - Assistant County Attorney
NOTES: .1 mineral acres/ 160 acres spacing unit * 15% = 0.00009375 MATCH
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