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EXHIBIT A <br />1029 -BD RECEIVES '! <br />^ff <br />GWS 1 Page 1 of 1 JV <br />06/09/00 SEP () b �' ltr)' Q 2006 <br />STATE OF COLORADO 'HATER RESOURCES "' � Coto. M k� <br />OFFICE OF THE STATE ENGINEEk ATE ENCf%IEER " <br />FAR <br />DIVISION OF WATER RESOURCES COLO, <br />1313 Sherman St. Room 821 <br />Denver, CO 80203 <br />(303) 866 -3581 Fax (303) 866 -3589 <br />NONTRIBUTARY GROUND WATER LANDOWNERSHIP STATEMENT <br />I (We) R c.k C o <br />(Name(s)) JAN ty <br />claim and say that I (we) am (are) the owner(s) of the following described property consisting of;rt*ra t Gpuncc' NFER <br />200 acres in the County of <br />State of Colorado: <br />(Insert the property legal description) <br />Z y y z 2 �� Se c+ p' o ►1 31 <br />7- <br />ou,KSti,y4 S6L A) Rai.-XSt- Co 3 cj <br />6� +-Ae 6t-1 P. M. <br />and, that the ground water sought to be withdrawn from the 16 we r D-. W s o h <br />aquifer underlying the above - described land has not been conveyed to reserved to another, nor has <br />consent been given to its withdrawal by another. <br />Further, I (we) claim and say that I (we) have read the statements made herein; know the contents <br />hereof; and that the same are true to my (our) knowledge. <br />�ume- 6 <br />A <br />re Date <br />,jignature <br />Date <br />...................... <br />INSTRUCTIONS: ............................................................................ ............................... <br />Please type or print neatly in black ink. This form may be reproduced by photocopy or word <br />processing means. See additional information on the reverse side. <br />1 111111 11III 111'1' 111111 III" 11'11'1111 1111111111111111 <br />484277 04/20/2007 02:38P 8693 P953 FAO <br />6 of 6 R 31.00 D 0.00 Elbert County <br />