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G;wS•1 pev.Sept.199C <br /> STATE OF COLORADO <br /> OFFICE OF THE STATE ENGINEER <br /> DIVISION OF WATER RESOURCES <br /> NONTRIBUTARY GROUND WATER AL _ND0VNERSHIP STATEMENT <br /> I Gve) the Colorado State Roard of Land Commissioners <br /> claim and say that I (we) am (are) the owner(s) of the following described property <br /> consisting of 1aso± acres in the county of Pueblo , State <br /> of Colorado: <br /> '(INSERT PROPERTY LEGAL DESCRIPTION) <br /> Jownshig 22 South, Range 65 West <br /> Section 22; NE;NENW;S2NW;N2SE;SWSE 400 acres= <br /> Section 27; W2E2; W2 a80 acres= <br /> Section 28; N2;N2SW;SESW;SE 600 acres= <br /> and, that the ground water sought to be withdrawn from the Cheyenne <br /> aquifer underlying the above-described land has not been conveyed or reserved <br /> to another, not has consent been given to it's withdrawal by another. <br /> Further, I (we) claim and say the ) (we) have read the statements made herein; <br /> know the contents hereof; and that the same are true to my (our own knowledge. <br /> (signature) ate) <br /> r 11 C:l�ll: vl�l.Ict I.,',a la;j�'r <br /> (Signature) (Date) <br /> ................................................................................................................................................ <br /> INSTRUCTIONS: <br /> Please type or print neatly in black Ink. This form may be reproduced by <br /> photocopy or word processing means. See additional instructions on back. <br /> 1313 SHERMAN ST RM 818 DENVER CO 80203 (303)866-3581 <br /> TOTAL. P.03 <br /> �, ryea �9 - <br />