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Home My WebLink About20140035.tiff NADOA Model Form Division Order(Adopted 9/95) DIVISION ORDER To: PDC Energy,Inc. Date: December 18.20 mIVED CC/'+C 1775 Sherman Street,Suite 3000 C C E Denver,CO 80203 Attn:Jenni L Mosier (303)831-3914orJenni.Mosier@pdce.com DEC 1 9 2n3 Property Number: 105.100769 Effective Date: March 14,2013 WELD COUNTY Property Name: Simonsen li-421 CD l'•ORIjORliR, Operator: PDC Energy,Inc Ae( ®5- 1213 -' 3 5q7 County and State: Weld,Colorado Property Taluals1424North.Range 67 West Description: Section 1 :NWNW(spaced Section 1:W2W2;2:E2E2; 11:NENE; 12:NWNW--399.278 acres) Production: X Oil X Gas X Other: all products Owner Name OWNER NUMBER: 43444 and Address: Weld County Board of Comm Type of Interest.: RI PO Box 758 Decimal Interest: 0.00018834 Greeley,CO 80632-0758 (0.376/399.2781 100%*20%) (Lot 1,Block 1) (Net Acres/Acres in Spacing Unit* %of net acres*Royalty Interest) The undersigned certifies the ownership of their decimal interest in production or proceeds as described above payable by PDC Energy,Inc.(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$50.00,or pay yearly 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 Attached Exhibit) Owner(s)Signature(s): ��'( .�. Pot,gl a G Radema her Chair • Board of Weld county Commissioners Owner(s)SSN/Tax I.D.Number(s): -.1 1 1-: �� :. • �.. �J�J�. - • �►► � � NI 2014 y�?, Owner Daytime Telephone: 970-336-7204 +id �' rk to the B' Owner Email Address: •�r`' = •1if�s� uty Cler' to the Board Federal Law requires you to furnish y( • ;�. ::1 ;; nr`i .:� payer Identification Number. Failure to comply will result in 28% „_ F;it� . y� 1 not be refundable by Payor JLM 'IMi" Retain this cony for your records 2014-0035 .LIrG4 �� /6, i�e rz ® ENDERGY Cor1775orate Se RECEIVED 1775 Sherman Street,Suite 3000 V�Y Denver,CO 80203 303-860-5800 DEr 9 c °- www.pdce.com WELD COI. .; c° December 18, 2013 Weld County Board of Comm PO Box 758 Greeley, CO 80632-0758 Re: Division Order— Simonsen 1 i-421 Dear Interest Owner: Enclosed are two copies of our Division Order for the above referenced well. The purpose of this Division Order is to provide you information about your ownership and obtain certification from you that you are the correct person to whom payments for this interest should be made. Please follow the enclosed "Instructions to Interest Owners"for executing and returning one copy of the Division Order to this office. The extra copy is for your records. The cut-off for changes in accounting is the 10th of the month. If we receive your Division Order 9 after the 10th, the pay change will take place the following month. If you have any questions pertaining to the calculation of your interest on the Division /Transfer Order, please feel free to contact me by e-mail at Jenni.Mosierc pdce.com or by phone at 303- 831-3914. Changes in ownership or address should also be directed to my attention. If you have questions pertaining to revenue or revenue checks, please contact the Revenue Department at the Bridgeport Office. Sincerely, PDC Energy, Inc. Jenni L. Mosier Division Order Analyst /jlm Enclosures • INSTRUCTIONS TO ALL INTEREST OWNERS Dear Interest Owner, PDC Energy,Inc.has enclosed a Division 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. 2. 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. 3. If signing for a corporation,signature must be attested,corporate seal fixed and title of signatory party reflected. 4. 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. 5. Your correct mailing address should be noted in the space provided to insure prompt receipt of production proceeds. 6. The top copy or the"Original"of the Division Order should be returned to: PDC Energy,Inc. 1775 Sherman Street,Suite 3000 Denver,Colorado 80203 Attn: Jenni L.Mosier 7. Should you have any further questions regarding the enclosed Division Order,please contact PDC Energy,Inc. at(303)860- 5836 or(888)860-5836. 8. Please DO NOT DETACH the exhibit from the Division Order or Transfer Order if one is included. I ' COGIS - WELL Information Page 1 of 1 COGIS - WELL Information Scout Card as Related CI. Insp. Q. MIT O GIS lit Doc it Wellbore Orders Surface Location Data for API # 05-123-35976 Status: F Well Name/No: Simonsen #11-421 (click well name for production) Operator: PDC ENERGY INC -69175 Status Date: 3/31/2013 Federal or State Lease#: County: WELD#123 Location: NWNW 12 6N 67W Field: SEVERANCE -#77030 Elevation: 4,848 ft. Planned Location 206 FNL 380 FWL Lat/Long:40.50839/-104.84984 Lat/Long Source: Fie Frac • * Job Date: 3/1/2013 Reported: 3/8/2013 Days to report: 7 Chemical Disclosure Registry Wellbore Data for Sidetrack #00 Status: PR 3/: Spud Date: 12/4/2012 Spud Date is: ACTUAL Wellbore Permit HORIZONTAL Permit#: Expiration Date: 8/16/20148:33:30 AP Prop Depth/Form: 12310 Surface Mineral Owner Same: Y Mineral Owner: FEE Surface Owner: FEE Unit: Unit Number Formation and Spacing: Code: CODL , Formation: CODELL , Order: , Unit Acreage: 400, Drill Unit GWA Casing: String Type: SURF , Hole Size: 12.25, Size: 9.625, Top: 0, Depth: 875, Weight: 36 Cement: Sacks: 730, Top: 0, Bottom: 875, Method Grade: Casing: String Type: 1ST, Hole Size: 8.75, Size: 7, Top: 0, Depth: 7830, Weight: 26 Cement: Sacks: 650, Top: 600, Bottom: 7830, Method Grade: Casing: String Type: 1ST LINER , Hole Size: 6.125, Size: 4.5, Top: 6514, Depth: 12310, We 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: 1 Twp: 6N 67W Footage: 500 FFSLL 200 FFWLL Depth Bottom Hole Location: Sec: 1 Twp: 6N 67W Footages: 500 FFNLL 200 FFWLL Depth Formation Log Top Log Bottom Cored Completed information for formation N-COM 1st Production Date: N/A Choke Size: Status Date: 4/1/2013 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=12335976&type=WELL 12/27/2013 Fr, :J.: �d v T 4 NI i ' yj�p: +'e-,4:',';/,''' , w t n . �.; ik:., ,r ni 1 yr 35. r • • r t ' +a; n ----,,,------e-' " 7 is ^Tn sz a361„ .. • m -d� Co t 4 L firr!':,1‘',.r.,-;'; Kf HP% .:,}y yy£ ')43, � 4, trg-A,.. 7 .O " ,* „? . . : t .' '. }' }",amr C> e - -10-?(6,,c,,,4 4t t:_�F,ay t 4,,,,,::::12-22: „ r _ T.o u . te +� 77ffaT�'` rar• >; • iS z ii"'.r T` * S )•1 dn) r .. a .< '��` ra ti" - `$2.: x etc, ...r E} a r in r ..,;qr «" r, 3K r t o ."s f*pac', .,P , ' n a W I F 4 'St ''^1 t Wiz. 1'*, i<. Z J q . 1 _ r , i aY N Me ,k r , t � crt S. L�N , : 3 , U � r ,. a 1 ;,2 .� i18 1S i� S lB• i _ .. a' -: ftiEZaN3r s y, _ -. 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COUNTY OF WELD, STATE OF COLORADO. . - ��:�: ; ---_- t- =- i? ,. 3::.•,.. _ r.I r . i�+� J. 4 Fr �' `� / '77J / i , .„,/ 0 , , ';' / ,� •/ / �:\�.i�.- f /. .,, 7 \�,, g ..J _((( t • _ , �\ '� ----fir .�... - ).- r y—, ......I•yf t9 I t tz t ►a �;� r- yy •FRANKLIN LANE FARM ), — ci 'eER (P.r} .. ._ • r 1 HUNTER ,11U SU6Di'151ON PHASE 1 ,: - hotrdir ci4 gcc.Ct naQ , t,n„ - `J ' •`- .v., HUNTER HILL Su9otwSOt;ij J t SECOND FIUi'O .•- •1 UU.iTER H,U. PA1O HOvuES • �� - FRANKLIN 5 ADO 1lo:i I TO THE TOV2 OF SEVERANCE 1H15 ;S NOT A LANE, SURVEY PLAT OR A BOUNDARY SURVE;1' NO MONUMENTS *ERE SET • GREEN MOUNTAIM SURVEYING SEE NOTES ON PAGE t • SAMUEL A. KNIGHT PROJECT LOCATION 1195 EDINBORO DR. PAGE 2 OF 12 SECTION 1. TOWNSHIP 6 NORTH. BOULDER. CO 80305 RANGE 67 WEST, 6TH PM I 303-601-8588 I "It is distinctly understood and agreed as evidenced by your acceptance of this opinion that PDC Energy and its subsidianes are m no way liable to any person,firm or corporation for any loss or inconvenience occasioned by the use or reliance upon this opinion" 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): Simonsen 1i-421 CD File Location(s): LE0315 BY: . '�"�1 �; DATE: 12 ✓73 Stephanie Arries Assistant County Attorney ACruo O , 3740 *1°f5 tfr1flt SW 271 Oyl ;076 , OOU «s3 imoibchk) Hello