HomeMy WebLinkAbout20143815.tiff NADOA Model Form Division Order (Adopted 9/95)
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DIVISION ORDER
To: Great Western Oil & Gas Company, LLC Date: October 15, 2014
1801 Broadway,Suite 500
Denver, CO 80202
Attn: Caitlin McEwen
API a5- a3-/03gia
Property Number: W11475 Effective Date: July 1, 2014
Property Name: PERRY 1
Operator: GREAT WESTERN OPERATING CO LLC
County and State: Weld, Colorado
Property Township 1 North, Range 65 West
Description: Section 10: E2
Production: X Oil X Gas X Other: all products
OWNER NAME AND ADDRESS: OWNER NUMBER: 1382
WELD COUNTY BOARD OF COMMISSIONERS TYPE OF INTEREST: RI
915-10TH ST DECIMAL INTEREST: 0.03076170
GREELEY , CO 80631
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 title
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 m av c
statutory rights under the laws of the state in which the property is located. Taq_
Special Clauses: one or Se ched Exhibit) 361 �A
.,
Owner(s) Signature(s): Dou las Rademacher, iT : c
WELD OUNTY B ARD O1 pi---
0 251 £ /W W1/ kw�
Owner(s) Tax I.D. Number(s): 84-6000-813 AttesDG`
Owner Daytime Telephone 970-336-7204 By
Owner FAX Telephone #: 970-336-7233 eputy C er to the Board
Federal Law requires you to furnish your Social Security or Taxpayer Identification Number.
Failure to comply will result in 31 %tax withholding and will not be refundable by Payor
CJM
Retain this cogv for your records 2014-3815
Comtra Acatibar
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Great Western
Great Western Operating Company, LLC OIL L GAS COMPANY Phone: 303.398.0546
1801 Broadway, Suite 500 Facsimile: 866.742.1784
Denver, CO 80202 Email: OwnerRelations@gwogco.com
www.gwogco.com
October 16, 2014
RECEIVED
RE: Perry 1
Tl N R65W OCT 2 0 2014
Sec. 10: E2 WELD COUNTY
Weld County, CO COMMISSIONERS
Ladies and Gentlemen:
Effective as of December 31, 2013, Great Western Oil & Gas Company (GWOC) acquired
the working interest of Whitewing Resources LLC and H L Willett Estate under the Perry 1.
GWOC took over as operator and will now be distributing 100% of the production revenue
associated with this well. The enclosed division order is based on the ownership deck
Whitewing was using prior to their divestiture of interest.
Attached please find two (2) copies of the captioned Division Order. 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
(Da2
4
4 2
T1 N-R65W
Perry Spacing Unit
9 10
7 'i
'15
14
Legend
Well Spacing Unit
Weld County Lease Great Western
OPERATING COMPANY, LLC
COGIS - WELL Information Page 1 of 2
COGIS - WELL Information
Scout Card D.. Related 4 Insp. 4 MIT O GIS at Doc at COA ir Wellbore a Orders
Surface Location Data for API # 05-123-10386 Status: PR 1/4/2010
Well Name/No: PERRY#1 (click well name for production)
Operator: GREAT WESTERN OPERATING COMPANY LLC- 10110
Status Date: 1/4/2010 Federal or State Lease#:
County: WELD#123 Location: NESE 10 1N 65W 6 PM
Field: WATTENBERG -#90750 Elevation: 5,003 ft.
Planned Location 1570 FSL 1130 FEL Lat/Long:40.062929/-104.644615 Lat/Long Calculated From Footages
As Drilled Location Footages Not Available Lat/Long:40.06297/-104.6445 Lat/Long Source: Field Measured
Wellbore Data for Sidetrack#00 Status: PR 1/4/2010
Spud Date: 10/3/1981 Spud Date is: ACTUAL
Wellbore Permit
Permit#: 19960907 Expiration Date: 12/11/1997
Prop Depth/Form: 8100 Surface Mineral Owner Same: N
Mineral Owner: FEE Surface Owner:
Unit: Unit Number
Formation and Spacing: Code: DKTA, Formation: DAKOTA, Order:499-15, Unit Acreage: 320, Drill Unit: E2
Formation and Spacing: Code:JSND, Formation:J SAND,Order:0, Unit Acreage: 320, Drill Unit: E2
Wellbore Completed
Completion Date: 1/25/1997
Measured TD: 8006 Measured PB depth: 8006
True Vertical TD: True Vertical PB depth:
Log Types: FDC; ISF
Casing: String Type: SURF, Hole Size: 12.25,Size: 9.625, Top: 0, Depth:213,Weight: 36
Cement: Sacks: 150,Top: 0, Bottom: , Method Grade:
Casing: String Type: 1ST, Hole Size:7.875, Size:4.5,Top:0, Depth:7907,Weight 10.5,11.6
Cement: Sacks:300, Top: 0, Bottom: , Method Grade:
Formation Log Top Log Bottom Cored DSTs
NIOBRARA 6957 N N
FORT HAYS 7272 N N
CODELL 7295 N N
CARLILE 7310 N N
GREENHORN 7376 N N
BENTONITE 7583 N N
D SAND 7700 N N
J SAND 7763 N N
Completed information for formation DK-J Status: 5/20/1997
1st Production Date: 1/22/1997 Choke Size:
Status Date: 5/20/1997 Open Hole Completion: Y
Commingled: Y Production Method: FLOWING
Formation Name: DAKOTA-JSND Status:
Formation Treatment
Treatment Date: 1/25/1997
Treatment summary:WELL DEEPENED FROM 7908 TO 8006 USING NITROGEN FOAM. COMPLETED OPEN HOLE.
DAKOTA WAS NOT LOGGED OR STIMULATED.
Tubing Size: 2.375 Tubing Setting Depth: 7772
Tubing Packer Depth: Tubing Multiple Packer:
Open Hole Top: Open Hole Bottom:
Initial Test Data:
Test Date: 5/20/1997 Test Method: FLOWING
Hours Tested: 24 Gas Type:
Gas Disposal: SOLD
Test Type Measure
BBLS_H2O 1
CASING_PRESS 480
http://cogcc.state.co.us/cogis/FacilityDetail.asp?facid=12310386&type=WELL 11/24/2014
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): Ottesen 1 File Location(s): LEOO62
Perry 1
•
BY: ` ? Z `' DATE: 7},c,. 3 , /Z i f
Bruce Ba _$aaD`(ecra .
k:4 County Attorney
NOTES:
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.
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