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CGLOKk00 EtORRC OF LRND COMM).SSI'GNCKS <br />520 Centennial 8uildin9, 1'61? Sherman Strr,:et <br />Uenuer, CG 60203, (303) 666-3247 <br />t4TKERRI RO1'RLTY REPO R7 <br />Lease Type LT GM GL GP QR hR C1' PL GE GS DH OS OM (CIRCLr: ONc) <br />State L~asc No. GP3395 Original X Ad}ustment <br />Counl-y~_Cnn_~jos _ Produr.C3on ivonth M Year ~~~~ .(l~y(~,~J~LS7~~Q~ / ,2D0`~, <br />Lessoc _ Proc~ced andJOr Operated Ey . <br />Subscc;zon_'SEQTR ~Section(s),4 _____7o~;inshi.p~~~_ ____Ran9o_ .. F3 <br />P^uduc,l Pi. t' Run - <br />Unit c Measure y0 fM LB 0'L o~ 0'f (CIRCLE ONE) <br />Deginnin9 InvenkorY Units Producad l~j~ ~i~ ~O _ <br />Ending Inventory units Sold <br />Sellsr~y Price Per Unit Gress Sales _ <br />Royalty Rate ,30 RoYALT'! CUE ~/Sr?~Sa <br />For F,d~usCed .Peports: Previous Rmount Paid. <br />Advanca.Minir;utn Rcya_i:y Credit (if applicable) _ <br />ROYALTY PkIO ~r'~7,v~~ <br />If this is an an adj~stn;ent, please explain_ <br />Contact 'Name Ph; ~ [,Eecr Telephone nto. 719-Sj39 ~F7 _ <br />I certify that this is a true and correct statan~~ent of production sold, value <br />received, and royalty due the State e~ Cclo,rado For the period indicated. <br />a •. <br />Authorized Si9naturc b Title <br />Reportinc Comaan;' r.'a~n~- A7amnGa Qo-"-n t3' Rn'ar] $, Brirdge TJUmber 70~ <br />Address 8fih3 ~ ('nnnr~ Rnarl 1QQ <br />Subscr'~u=d anc Sworn ~:o beFore me by QIy~/~`~~~,~1~f <br />O.. This 1~ day or" ~'~'~'~?~.. _`~ ~~~" <br />I•;y 'ComrnissionlExp e~ \(.iY ~"I~l~ _ Cl() <br />N c, z r y. ? u b l i c , ~.UI /r-v~""0~ _ `,-~ (yX.VLC/h-- <br />Cate' StamF Land Eoard Usc Only <br />Verified ____Rcceipt No. <br />Posted Dat <br />Notes <br />