HomeMy WebLinkAbout20143816.tiff RETAIN
EXTR CTION
r&
Gas
\'DO%%lode'Fonn Oh ii on Orden\domed 9 9C1—
DIVISION ORDER
Io: Extraction Oil and this.I.I,C Date: 11/06/2014
1888 Sherman Street. Suite 200
Dent cr.Colorado 8O_03
Well/Property Name: Rubvanna 13C-32W ACi 05
Well API Number: 05-123-38914 t' -.a3-389j4
Well/Property Number: CO0306
County and State: Weld County,Colorado
Property Description: Township 6 North,Range 67 West,Section 13&Section 24
Spacing Unit Acres: 324.1101 gross acres
Production Type: X Oil X Gas Other:
Owner Number: WELD COUNTY CO BOARD OF COUNTY Type Interest: Decimal
12105 COMMISSIONERS R Interest:
1150 O STREET .00134600
GREEI,EY,CO 80632
the undersigned cerli lies the ownership of their decimal interest in production or proceeds as described abole pal able by
Extraction Oil and Gas. I.LC("Payor).
Pay or dial] be notified.in writing.of an) change in ownership. decimal interest.or pay meni address- All such changes shall
he elieetis e the first day of the month following receipt of such notice.
Pay or is authorized to ww ithhold pay ment 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. Pay or any amount
attributable to an interest to"hich the undersigned is not entitled.
Pay or may, accrue proceeds until the total amount equals$100 00.or pay annually. whichever occurs Inst.or as required by
applicable state statute.
I his Di)ision Order does not amend an) 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 Diyision Order.the undersigned and Pay or maw how c certain statutory rights
under the Laws of die state in which the property is located.
A facsimile or scanned cop'of a signed copy of this Diyision Order shall be deemed an original.
Federal Law:requires you to furnish your Social Security or Taxpayer Identification Number. Failure to
comply will result in 28%tax withholding and will not be refundable by Pay or.
Signatures of Witnesses: one (s)5kw - Owner(s) lax I.I).(SSN or IAN 1:
' ,' .tom— 84-6000-813
ugh s Rade acher, Chair
DEC 1 0 2201(4/�/��
;
1"e t � V• Ks/u
.+ 2i`w N�ttest. WPhone Number(npunnai):
F -' 'Per to the Board
E ie D 970-336-7204
c i
Fax Number
� � ( '' 96-7233
k ,gel: it . k., 'Deputy C erk to the Board
- 2014-3816
COnutrUt A CEO I43
COGIS - WELL Information Page 1 of 1
COGIS - WELL Information
Scouts Related Q Insp. Q MIT 0 GIS a Doc Lei COA 'Ir Wellbore a Orders
Card
Surface Location Data for API # 05-123-38914 Status: DG 5/15/2014
Well Name/No: RUBYANNA#13C-32W (click well name for production)
Operator: EXTRACTION OIL&GAS LLC-10459
Status Date: 5/15/2014 6:00:00 AM Federal or State Lease#:
County: WELD#123 Location: SESE 13 6N 67W 6 PM
Field: WATTENBERG -#90750 Elevation: 4,825 ft.
Planned Location 701 FSL 225 FEL Lat/Long:40.48174/-104.83321 Lat/Long Source: Field Measured
Wellbore Data for Sidetrack #00 Status: DG 5/15/2014
Spud Date: 5/15/2014 Spud Date is: NOTICE
Wellbore Permit HORIZONTAL
Permit#: Expiration Date: 2/11/2016 1:31:02 PM
Prop Depth/Form: 11825 Surface Mineral Owner Same:
Mineral Owner: FEE Surface Owner FEE
Unit: Unit Number:
Formation and Spacing: Code: CODL, Formation: CODELL,Order: , Unit Acreage: 320, Drill Unit:
Casing: String Type: SURF, Hole Size: 12.25, Size: 9.625,Top: 0, Depth: 700,Weight: 36
Cement: Sacks: 372,Top: 0, Bottom: 700, Method Grade:
Casing: String Type: 1ST, Hole Size:8.75,Size:7,Top: 0, Depth: 7437,Weight: 23
Cement: Sacks: 707,Top:3000, Bottom:7437, Method Grade:
Casing: String Type: 1ST LINER, Hole Size:6.125, Size:4.5,Top: 6700, Depth: 11825,Weight: 11.6
Cement: Sacks: ,Top: , Bottom: , Method Grade:
Wellbore Completed
Completion Date: N/A
Measured TD: Measured PB depth:
True Vertical TD: True Vertical PB 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=12338914&type=WELL 11/24/2014
EXTR CTION
0:18 Go,
INSTRUCTIONS TO ALL INTEREST OWNERS
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: RECEIVED
1. Sign your name as shown on the Division Order.
N1/4,
2. Have your signature witnessed by two competent witnesses.
WELD COUNTY
3. If your name has changed due to marriage or divorce,execute the Division Order COMMISSIONERS
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 return with your division order.
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 top copy or the"Original"of the Division Order should be returned to:
EXTRACTION OIL AND GAS LLC.
1888 Sherman St., Suite 200
Denver, Colorado 80203
Attn: Tara Peters
10. Should you have any further questions regarding the enclosed Oil Division Order,
please contact Tara Peters at tpeters@extractionog.com
11. Please DO NOT DETACH the exhibit from the Division Order if one is included.
EXTRACTION OIL AND GAS,LLC,1888 SHERMAN ST,SUITE 200,DENVER,CO 80203-PHONE 720-557-8300
in
C)
CU
L
Y
O
N
C
O
Y
U
O
N T
>-.
I-
O .O
a
H Y
N
CU a
N N
L
Y C
O cu
T C
a o
o
u v,
no
to
v c 3
L O O
U C C)
co -O
a
to v O OC
U N •._
m Y ro
L 0O I. L —
0
oo r no
Q co C)
ri z C a+ O
m -- O O C
N Z Y O -O
a N J LO G C N
V J
C Z ..C 'O a) in
N O [ N al CO
_.. rr� v v o .,
a N N C v,
O J O- T
U O J c
cc _ I-I CU
O t-, c. 0 >
fa Vf r `1- II en ,- c
m L
CU
E2 to r• raa c .4 u v in , i
O 't X co a m T
mr « N •— O m C C O
Y
V E ° t 3 II U U
.0 V a O o - C 'C aJ 'O L
N p U J. w rl " L H m a) r.•
X N O j o N L u. a! > 3
ID LI
E2 N > U • to o CU
to O O .C
-O "O w f. N y0 L a
$ � OD I-I
a a) c j 'v o u .O CO0 ai y
H Jrn _O a) v
w Z O .� u ,� G , E .� o c 4
-o ON
_ , . ., x .0 c in O .�
>pa co a, oc r r, a, 15 m N E 5
a -OW dN <^ 'r '" a E
0 coV`1 5. N N a r+i J > • O
N J O -coC
co L to W W i_ Z U j V. 'O J CO '= ro
v
-o N -a C Y. '� U Y N
J• "O i .., Im. C U CU T O
E
✓ u H j G re c - C O 7'
C CU f 7 ._ > O .- 0
CU Y MD C > L U to
a N
V
>, a a / ? 3 3 v 0
G c c N o % �. o c
CuLL f. t O O w to t 7 s u Cr to O
U in ^ O
E •
.. N o LL -O 3 'v .r ._ to N 3 3
c a m Lc, Cl O O O
R Q ai •o J .. a'
Y ILNF0Q 2 yL-- 2 H .7t rs m O
m
Y
al Ln
Y 72> a)
o E
0
u
N o
CD L
a u
= L
O
>, 4-
C o
ro E
U a)
L
C
o Y
c
ro 02
U c
CO
U in
a) T
c
a)
Y
M, c _c
Y
>kk
CO L
T c
O L
Y
cu cu
c 00
cc O
CI w >,
a
X
r, a
ma o Li
c
0 o a)
Y
O CO
E L
D
x al c v
Z aal
Y "O
a Q ° a `o
yk H CV E L o
O ,- X
q O N W 7,
in D0 J OO
a) c O- c a)
E a _c
CO .c a) u o
C c c
O O o N
ti vi
U a+ a)
co
- 0 Q A N
m -0
>' Es.
cCI O
E O E
n U
H
ri -to r cccc o `° 0 Q o a) a)
ro
vr, r `" -o w E 3
7 J. LO m 3 of a)` `._ `off
C. G V 0 -o ro
• " O Z r�� o O o
X Y. O ° v rV c c Ln N
rr. K, ; ry 'o O o m L-
J J c in — _o -O m E
N O ,n Lc N To E ��, O M1in u cv
c
p m r0 Q) 'c v c L c o. ._
>• _ s o c v my m v E o 0 c a E
co- _ _v d Q y , V) o ad -� Z o 4.-.
ro v r0
Y W n
Lei
J! .+! m Q ,.n m °� lir W r9 aO+ a v u >• C
-o ^ CC 3 a O o ° v O o a cu Y a° 0 o te
in ai;r rI i..... ri H 3 Lil a a .� ruo v o 2 `- u ≥ .c
ry ° o n v o 4413
� E C i a a,
o .- C) i- > co c rrd u o
L °' CO - O (V ° a) 07 @ Eo
N CC LL H CA H _ O ,-i
Karla Ford
From: Tara Peters [TPeters@extractionog.com]
Sent: Monday, November 24, 2014 10:18 AM
To: Karla Ford
Subject: RE: Rubyanna 13C-32W
Extraction is the operator of this well.
Tara Peters
Division Order Analyst
Extraction Oil & Gas
Direct: 720-557-8316
1888 Sherman Street, Suite 200
Denver, CO 80203
EXTRCTION
oils Car
From: Karla Ford [mailto:kford@co.weld.co.us]
Sent: Monday, November 24, 2014 9:53 AM
To:Tan Peters
Subject: Rubyanna 13C-32W
Importance: High
Tara,
I am working on this division order and I show that the lease with Noble Energy, Inc. Is Extraction just the producer, not
the owner? Please advise.ThankS!@
Karla Ford R
Deputy Clerk to the Board
1150 O Street/P.O. Box 758
Greeley, CO 80632
tel: (970)336-7215 X4228
tjri , �
j i
� r
Confidentiality Notice:This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed
and may contain information that is privileged,confidential or otherwise protected from disclosure.If you have received this communication in error,please
immediately notify sender by return e-mail and destroy the communication.Any disclosure,copying,distribution or the taking of any action concerning the contents of
this communication or any attachments by anyone other than the named recipient is strictly prohibited.
1
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): Rubyanna 13C-32W File Location(s): LE0143
BY: C-CtaeOll -�
DATE: //�s• D,
Ste ha� zs, Yarn er-
Assistant County Attorney
NOTES: 3.49 mineral acres/ 324.1104 acres spacing unit * 12.5% _ .001346 Match
Hello