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<br />Texas Water Dev. Board <br />issued May 13, 1994 <br />page 2 of 2 BANKBUY <br /> <br />" <br /> <br />TEXAS WATER BANK <br />REQUEST FOR REGISTRATION AS A BUYER <br /> <br />IF GROUND WATER IS DESIRED TO BE PUR01ASED: <br /> <br />Describe the location of the desired ptmpage point if known, or of <br />the general place of use (attach a page for descriptions of any <br />additional locations) <br />Aquifer County <br />Latitude/Longitude (in decimal degrees) Lat Long <br />In lieu of lat/long, attach County Highway Map, USGS 7.5 I tapa <br />map, or other map with the desired pumpage point(s) or the <br />general place (s) of use marked. <br />Name of underground Water Conservation District or Authority <br />with jUrisdiction (if applicable) <br /> <br />Ground water may be subject. to ':r;estrictions on purrping illJlOsed by <br />legislative mandate and/or as regulated by authorized districts or <br />authorities (Harris-Galveston Coastal Subsidence District, High Plains <br />Underground Water Conservation District, etc.) <br /> <br />Indicate <br />o <br />o <br /> <br />the Proposed Type of Use: <br />Municipal/Domestic 0 <br />Irrigation 0 <br /> <br />Industrial <br />Mining <br /> <br />o other <br /> <br />List any special needs/constraints below. <br /> <br />A registered buyer with the Texas Water Bank is a participant in the <br />Water Bank with responsibilities as outlined in the handOut, "Texas <br />Water Bank Participant Responsibilities". Please indicate your <br />understanding and acceptance of these responsibilities and of the Water <br />Bank Rules by your signature below. Co-registrants should also sign. <br />If signing {"or a buyer, so indicate on the signature line and attach <br />documentation showing authorization to represent the buyer. Thank you. <br /> <br />Signature <br /> <br />(for) <br /> <br />Date <br /> <br />Additional signatures for co-registrants, if applicable <br />