. JDF 308 W R 7 - 13 APPLICATION FOR UNDERGROUND WATER RIGHTS IN THE DENVER BASIN Page 1 of 6 AQUIFERS AND CERTIFICATE OF NOTICE District Court, Water Division , Colorado Court Address : CONCERNING THE APPLICATION FOR WATER RIGHTS OF Applicant: In the River or its Tributaries In COUNTY COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division: Courtroom: APPLICATION FOR UNDERGRO U ND WATER RIGHT S IN THE DENVER BASIN AQUIFERS 1. Name, address, email address, and telephone number of applicant(s) (if there are multiple applicants, and the space provided is not adequate to list all of the applicants, the names, addresses, telephone numbers and available email addresses must be provided as an attachment) : Name of Applicant Address Email address Telep hone Number If multiple applicants are listed the following must be completed: All of the applicants listed have joint ownership of the parcel(s), and/ or joint consent to withdraw the water underlying the parcel(s) , which is/ are the subject of this application. The Applicants own separate parcels of land , and/ or have consent to withdraw the water underlying separate parcels of land, and request that this Court determine that Applicants have the right to withdraw all of the legally available groundwater lying below all of the subject parcels of land, through a single well or multiple wells constructed at any location on the subject parcels of land. In addition the applicant claims: All of the parcels of land claimed in this application are contiguous ( that is, no part of land claimed in the application is physically separate from the rest of the land ) , or The parcels are non - contiguous but could satisfy Rule 11.B of the Statewide Nontributary Ground Water Rules (2 CCR 402 - 7) as demonstrated by the attached information (documentation of such claim must be attached) . Please see the instructions regarding this Rule if the applicant has questions. American LegalNet, Inc. www.FormsWorkFlow.com . JDF 308 W R 7 - 13 APPLICATION FOR UNDERGROUND WATER RIGHTS IN THE DENVER BASIN Page 2 of 6 AQUIFERS AND CERTIFICATE OF NOTICE 2. Background: A. Parcel description information (if multiple parcels are being described the information shown below must be provided for each parcel along with a map and legal description of the parcel , as an attachment ) The parcel of land consist s of acres, more or less, in County (or Counties) , located generally in Section(s) , Township(s) , Range(s) , of the 6 th Princip al Meridian (attach a map) . A legal description of the subject parcel of land is attached hereto Subject B. Parcel ownership: The claim of Applicant(s) to the water underlying the parcel ( s ) described in 2A is based on ownership of the parcels: Yes No . If No , the Applicant must provide a) the written consent from the owner(s) of the overlying land to the applicant, which consent includes a legal description of the land and identification of the aquifers for which consent has been given, and b) an instrument evidencing ownership of such land by such consenting owner(s) at the time such consent was granted . C. This application seeks a decree adjudicating all or part of the nontributary and not nontributary ground water in the Denver Basin aquifers underlying the Subject Property . S uch aquifers may includ e the Upper Dawson, Lower Dawson, Denver, Upper Arapahoe , Lower Arapahoe and Laramie - Fox Hills aquifers ; t he actual aquifers will be those that are determined to be available underlying the Subject Property in accordance with the Denver Basin Ru les (2 CCR 402 - 6). The Applicant (s) seek to adjudicate the Denver Basin ground water underlying the Subject Property in all of the available aquifers , or The Applicant (s) seek to adjudicate the Denver Basin ground water underlying the Subject Property in all of the available aquifers , except for the following a quifer ( s ) : . The Applic ant(s) may seek to not adjudicate a portion of the water in one or more of the claimed aquifers. If the Applicant ( s ) desire to not adjudicate a portion of the Denver Basin ground water the aquifers and amounts, in acre - feet per year, sought to be excluded from the decree must be specified . D. Applicant certifies (check one as appropriate): T hat Applicant (s) own the Subject Property free and clear of all liens and encumbran ces and that no other person or entity has a financial interest in the Subject Property . Accordingly, Applicant certifies compliance with the notice requirements of 247 37 - 92 - 302(2), C.R.S. All record owners of the Subject Property not listed as Applicants herein, and every person who has a lien or mortgage on , or deed of trust to , by certified or registered mail, return receipt requested, no later than 14 days after the fili ng of this Application. Complete and file with the Court the attached Certificate of Notice as evidence that the required notices were given. E. There are wells located on the property. Those wells are permitted/registered under well permit no ( s ) . F. The application is seeking to adjudicate the existing well ( s ) located on the property (If this application has more than one applicant , owning or claiming consent for separate parcels of overlying land , the existing wells cannot be adjudicated under this application) : Yes No . American LegalNet, Inc. www.FormsWorkFlow.com . JDF 308 W R 7 - 13 APPLICATION FOR UNDERGROUND WATER RIGHTS IN THE DENVER BASIN Page 3 of 6 AQUIFERS AND CERTIFICATE OF NOTICE An Exhibit 1 must be completed and provided for each well that will be adjudicated , if the Applicant is not seeking to adjudicate a well , Exhibit 1 is not required . 3. Remarks: Signature of Applicant(s) (if self - represented) or Attorney Date VERIFICATION AND ACKNOWLEDGMENT OF APPLICANT OR OTHER PERSON HAVING KNOWLEDGE OF THE FACTS STATED IN THIS APPLICATION Being first duly sworn, I hereby state that I have read this A pplication, that I have personal knowledge of the facts stated and , that I verify it s contents to the best of my knowledge, information, and b elief. Signature Date T he foregoing instrument was acknowledged before me i n the County of , State of Colorado, this day of , 20, by the person whose signature appears above. My Commission Expires: Notary Public/Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com . JDF 308 W R 7 - 13 APPLICATION FOR UNDERGROUND WATER RIGHTS IN THE DENVER BASIN Page 4 of 6 AQUIFERS AND CERTIFICATE OF NOTICE Exhibit 1 - Page of 1. Name of well and permit or registration (Attach a copy of the well permit or registration) . Name of Well Permit or Registration Numbe r 2. Required Legal description of well: L ocation information in UTM format (Preferred): UTM Zone must be 12 or 13; Units must be Meters; Datum must be NAD83 ; and Units must be set to true North. Include the source of the UTM coordinates , for example : GPS device ; GIS system such as DWR AquaMap or CDSS MapViewer; scaled from USGS topo graphic map ; or other source. In areas ha ving generally recognized street addresses, also include street address, and if applicable, the lot, block, and subdivision . A ttach a legible 8 275 x 11 inch map to this application illustrating location of the structure . UTM coordinates Northing Easting Zone 12 Zone 13 Street Address: Subdivision: Lot Block Source of UTMs ( for example , hand - held Garmin GPS): Accuracy of location displayed on GPS device ( for example, accurate to within 200 feet): Legal Description Using the Public Land Survey System (PLSS) (Optional ; Please include both UTM and PLSS descriptions if known ) : I nclude perpendicular distances from section lines, and indicate 274 274, section number, township, range , meridian and county ; mark the location of the structure on a USGS topographic map and attach to this application a legible 8 275 x 11 inch copy of the applicable portion of the map. In areas where section lines have not been established, a bearing and distance to an established government monument is acceptable. Include the source of PLSS information , for example: GIS system s uch as DWR Aq