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Home My WebLink About20153019 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: W10977 Effective Date: First Sales Property Name: KODAK NORTH FD 28-119HN Operator: GREAT WESTERN OPERATING CO LLC �pj 00-/g ---,3q43/4 l County and State: Weld, Colorado Property rnw chin North Range 67 West Description: Section NW 0 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. Il 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. IIII Special Clauses: (N ne o See Att d Exhibit) Owner(s) Signature(s): akt- Barbara Kirkmeyer, Chair WELD COUNTY; ommissioners dirdtdA) G . +LD•,el ill Owner(s) Tax I.D. Number(s): 84-6100-81 EP111. ! A Cl: s the Bo.rd Owner Daytime Telephone 970-336-7204 Owner FAX Telephone #: 970-336-723 �E�Y' . puty C /.rk to th;� y90rd Owner Email Address MI ( O 42 2015-3019 6) %,,, . Federal Law requires you to furnish ri r Taxpayer Identification Number. '►+ � i� Failure to comply will result in 31 %t• - f, nd will not be refundable by Payor CJM Retain this copy for yo rec ds rida--' / Z ' L6L-1-41--jk-°--- , - /v aaq 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 Mc Ewen 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 . 6. , 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 www.gwogco . com June 24 , 2015 RE : KODAK NORTH FD 28-082HC KODAK NORTH FD 28- 1 19HN T6N R67W T6N 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 welts 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 Caitlin McEwen Division Order Analyst Enc 3 13/4 ...u. Cr T` ni a1/4.) at Ci o tn CI ki) I Ems '- 4 M • O O : co O O O O cu BOO t y a O `� ` CC a l tn N d' o ri y N `p 0 t-+ Cr, oo 3 v0 J O 0 sa- ,-4z ci. _,, ..4 n4 o O a ["' I r--� o rn Y v f m a) Li 0 0 cn � -2 � XOO © m 0 0 o 0 C L.r1 C O . O V 4.L, 00 N Q) r-1 > .�, E..y C.) E o o 5 v CO 0 0 C _ O O w --+ U e00 V '2 4.4O O 2 o 03 "- O O C 73 am 92 _ 0 0 . _ ca 0 r--+ • I i--� = i en u I__ �C 0C in E m IcNi 12 0 E 7) at it 'c c � 3 'U o 0° _ ',, J 0 � ., .,.ice w iri so L I.. • •O E '�7) a)cip N O o ct) y �, ccl IE ij a 4 w Lrte! rte/ r... 7 2 . . C� :S4 1 C � Great Western Operating Company, LLC March 3 , 2015 Page 21 Total 100.000000 % Tract 4 - Leasehold Ownership : Name WI NRI LEASE 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% LEO Sg 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 LE 623 . 100 . 000000% Total 100.000000 % Tract 5 - Oil and Gas Ownership : Weld County, Colorado 100. 000000% Total 100.000000% Tract 5 - Leasehold Ownership: Name WI NR.I 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 100.000000% 100.000000% Great Western Operating Company, LLC March 3 , 2015 Page 25 Tract 9 - Leasehold Ownership : LE033O (As to all formations) Name 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 2nd 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 Ownersfip : 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% (ORl) G Affirm Energy, LLC 0 .500000% (OR !) 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 lying in the E/2NE/4 of Section 28 and 0 .022 acres, ± to that portion lying in the W/2NE14, for a total of 0. 109 acres, ± 1 S Vl Co a) N E --• D c,,, M O) O N CC0 U I1 N C C, o) a) ti c0 Z t0 N M Co N M I- COGIS - WELL Information Page 1 of 1 COGIS - WELL Information Scout Card h Related Cit. Ins : Qs MIT 0 GIS a Doc 4 COA if Wellbore a Orders Surface Location Data for API # 05- 123- 39347 Status : XX 4/27/2014 Well Name/No : Kodak North FD #28- 119HN (click well name for production ) Operator: GREAT WESTERN OPERATING COMPANY LLC - 10110 Status Date : 4/27/2014 9 : 30 : 59 PM Federal or State Lease #: County : WELD # 123 Location : SENW 26 6N 67W 6 PM Field : WATTENBERG - #90750 Elevation : 4 , 760 ft. Planned Location 2253 FNL 2030 FWL Lat/Long : 40 . 459008/- 104 . 863069 Lat/Long Source : Field Measured Job Date : 5/25/2015 Frac Focus Job End Date : 6/4/2015 Reported : 6/19/2015 Days to report: 15 Chemical Disclosure Registry Wellbore Data for Sidetrack #00 Status : XX 3/26/2014 Wellbore Permit HORIZONTAL Permit #: Expiration Date : 4/26/2016 9 : 30 : 59 PM Prop Depth/Form : 13975 Surface Mineral Owner Same : Mineral Owner: FEE Surface Owner: FEE Unit: Unit Number: Formation and Spacing : Code : NBRR , Formation : NIOBRARA , 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 : 1180 , Weight: 36 Cement: Sacks: 455 , Top : 0 , Bottom : 1180 , Method Grade : Casing : String Type : 1ST , Hole Size : 7 . 875 , Size : 5 . 5 , Top : 0 , Depth : 14807 , Weight: 17 Cement: Sacks: 1592 , Top : 0 , Bottom : 14807 , Method Grade : Casing : String Type : 1ST LINER , Hole Size : 6 . 125 , Size : 4 . 5 , Top : 6500 , Depth : 13976 , Weight: 11 .6 Cement: Sacks : 405 , Top : 6500 , Bottom : 13976 , 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 : 1475 FNL 1825 FWL Depth Bottom Hole Location : Sec: 28 Twp : 6N 67W Footages : 1475 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= 12339347&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 I Kodak North FD 28 - 082HC LE0330 BY' DATE : 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 Hello