2008-08-28_GENERAL DOCUMENTS - C1980001 ‎(2)‎

• Permit No: C1980001
• IBM Index Class Name: General Documents
• Doc Date: 8/28/2008
• Doc Name: Monitoring Well Transfer of Ownership
• From: WWCEngineering
• To: Maplewood Financial, Inc
• Permit Index Doc Type: Exploration
• Email Name: JDM
• Media Type: D
• Archive: No

Form STATE OF COLORADO For Office Use Only
No. OFFICE OF THE STATE ENGINEER
GWS-1 818 Centennial Bldg., 1313 Sherman St., Denver, CO 80203
6/2006 [phone] Fax [phone]
hftp://water.state.co.us/default.htm
REGISTRATION OF EXISTING WELL
NAME ADDRESS AND PHONE OF THE WELL OWNER:
NAME(S)
Maplewood Financial, Inc. c/o William Dulan
MAILING ADDRESS
3001 S. Lincoln Ave.
CITY: STATE: ZIP CODE:
1
80487
Steamboat S rings CO
T TELEPHONE NUMBER E-MAIL (OPTIONAL)
[phone]
WELL LOCATION County RouttOwner's Well Designation (optional) GMC2
N/A .. N/A CO N/A
(Address) (City) (State) (Zip)
SW 1/4 of the NE 1/4, Sec. 36 , Twp. 5 ® N. or ? S., Range86 ? E. or ® W., 6th Principal P.M.
Distance from Section Lines 2606 Ft. ® N. or ? S. Line, 2502 Ft. ® E. or ? W. Line.
PLEASE ATTACH A COPY OF A CURRENT DEED FOR THE SUBJECT PARCEL
Subdivision Name N/A , Lot , Block , Filing/Unit
Optional: GPS well location information in UTM format. The following GPS settings are required: Easting 331492.41
Format must be UTM. Units must be in meters. Datum must be NAD83. Unit must be set to true
north. ? Zone 12 or ® Zone 13
Northing 4468148.36
Was GPS unit checked for above items? ® YES F1 NO
The well has historically been used for the following purpose(s): Monitoring Well, Dual Completion 5" PVC and 1" PVC

Water from the well was first used beneficially by the original owner for the above described purposes on Unknown
The total depth of this well is 235, 164.3 feet.
The pumping rate of this well is N/A gallons per minute.
The average annual amount of water diverted is N/A acre-feet.
The lawn and garden irrigated (watered) by water from this well is N/A ? Acre or ? Square feet.
Number
The making of false statements herein constitutes perjury in the second degree, which is punishable as a_class 1 misdemeanor pursuant to
C.R.S. 23-3-104(13)(a). I have read the statements herein, know the contents thereof, and state that they are true to my knowledge.
Signature(s) of the Well Owner Print Name and Title of Well Owner Date

For Office Use Only
WE
WR
CWCB
TOPO
MYLAR Div WD _ Basin MD