WSP03541

• File Number: 8126.700
• Description: Arkansas River Coordinating Committee - Committees - Subcommittees
• State: CO
• Basin: Arkansas
• Water Division: 2
• Date: 11/1/1994
• Author: Texas Water Develop
• Title: Texas Water Bank
• Water Supply Pro - Doc Type: Report/Study

issued May 13, 1994
page 2 of 2 BANKSELA.

"

TEXAS WATER BANK
REQUEST FOR REGISTRATION AS A SRT ,T ,m

IF THE WATER oFFERED FOR SALE IS GROUND WATER:

Describe the location of the authorized pumpage point or ~eneral
place of use (attach a page for descriptions of any additional
locations)
Aquifer County
Latitude/Longitude (in decirral degrees) Lat Long
In lieu of lat/long, attach County Highway Map, USGS 7.5 I tope
rrap, or other rrap with pmrpage poUlt (s) or general place (s) of
use rrarked
Narre of Under;:JZ'ound Water Conservation District or Authority
with jurisclictlon (if applicable)
attach a xerox copy of groundwater withdrawal authorization or
permit and give permit ntm1ber here

Indicate
o
o

the ~ of Use:
MuniClpal/Domestic
Irrigation

o
o

Industrial
Mining

o other

A registered seller is a participant in the Texas Water Bank with
responsibilities as outlined in the handout, "Texas Water Bank.
Participant . Responsibilities". Please indicate understanding and
acceptance of these responsibilities and of the Water Bank Rules by your
signature below. Co-owners of the water right should be in a~eement
and should sign as co-registrants. If signing for seller(s), so Uldicate
on the signature line and attach documentation showing authorization to
represent seller(s). Thank you.

r/we, the undersigned, attest to the truth, accuracy and canpleteness of
the information I/we have provided on this form to the best of rnv/our
knowledge, understand Water Bank Rules and rrry/our role as a particlpant
in the Texas Water Bank.

Signature

(for)

Date

Additional signatures for co-registrants, if applicable

Notary Public signature and seal