PROJ00455

• Contract/PO #: C153583
• Contractor Name: Ute Water Conservancy District
• Water District: 0
• Bill Number: XB 99-999
• Loan Projects - Doc Type: Feasibility Study

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SUPPLEMENTAL

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NOTE The responsible agencv(les) will proVide additional instructions. CHECK APPROPRIATE
BLOCK
I - PRIVATE CORPORATIONS ATTACHED FILED"
Articles of IncorporatIon ~ L~
a, ~-
b, Corporation Bylaws 0 0
A certiflcatlOn frofT! the State showing the corporation is in good standing and is entitled to operate within the [J ~
c. State. -
d, Copy of resolution authorizing filing ,~ ~
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e, The name and address of each shareholder owning 3 percent or more of the shares, together with the number
and percentage of any class of voting shares of the entity which such shareholder is authorized to vote and
the name and address of each affiliate of the entity together with, in the case of an affiliate contr(1fTed by the n r-
entIty, the nUlT.ber of shares and the percentage of any class of voting stock of that affiliate owned, directly ~ ~
or indlTectly, by that entIty, and in the case of an affiliate which controls that entity. the number of shares
and the percentage of any cl?ss of voting stock of that entity owned, directly or indirectly, by the affiliate.
f, If application is for an oil or gas pipeline, describe any related right-of.way or temporary use permit appli- :=J ;-,
catJOns, and identify previous applIcations. --
g, If applicatJOn is for an 011 and gas pipeline, identify all Federal lands by agency impacted by proposal. "
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II - PUBLIC CORPORA TIONS

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a, Copy of la...... forming corporation ,
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b, Proof of organIzatIOn 0 0
c, Copy of Bylaws L: n
d, Copy of resolutIon authorizing filing 0 C
e, If appl icatlon is for an oil or gas pipeline, provide informatIon required 0 [J
by Iten: "I-f" and "I_g" above.

l!l - PARTNERSHIP OR OTHER UNINCORPORATED ENTITY

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a, ArtIcles of association, If any n n
b, If one partner is authonzed to sIgn, ;-, [J
resolution authorizing action is L
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c, Name and address of each participant, partner, association, or other L
d, If applicatlOn IS for an oil or gas pipeline, provide information required 0 "
by Item "I-f" and "I.g" above. ~

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. If the requlTed mformation IS already filed with the agency processing this application and is current, check block entitled "Filed,"
PrOVIde the file IdentrficatlOn informatlOn (e.~., number, dale, code, name). If not on file or current, attach the requested information.

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EFFECT OF r'ovT PROVIDING !NFORMATION: Disclosure of the
information is voluntary. If all the information is not provided, the
application may be rejected.

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NOTICE
The Privacy Art of 1~'i4 provides that you be furnIShed the
following information in connection with information required hy
thIS applicatlOn for an authorization.
AUTHORITY 16 U.S.c. 310: 5 U.S.C 301.
PR!NCIPLE PURPOSE The InformatlOn is to be used to process
the application.
ROUTINE USES (1) The processing of the applicant's reque31
for an authonzation. (2) Documentation for public informatIon.
(3) Transfer to appropnate Federal agencles when concurrence
is requl~ed pnor to grantlOj;!: a right in public lands or resources.
(4)(5) InformatIon from the record and 'or the record will be trans-
{erred to approprIate Federal. State, local or foreign agencies,
when relevant tc. c.ivil, cnfTllnal or regulatory investigations or
prosecutions.

DA T A COLLECTION ST A TEMENT
The Federal agertcies collect this information Crom applicants
requesting right-oC-way, permit, license, lease, or certification for
the use oC Federal lands.
The Federal agencies use this information to evaluate the ap-
plicant's proposal.
The public is obligated to submit this form if they wish to obtain
permission to use Feder.ll.nds.

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..u.s. C;over...ent Pnntlng OffICe: '9~Q-_';".,"t,0009o