District Court, Water Division ___________________, Colorado Court Address: CONCERNING THE PROTEST OF Protestant/Owner: TO REVISED ABANDONMENT LIST OF WATER RIGHTS INVOLVING WATER RIGHT IN _____________________ COUNTY If Represented by an Attorney, Attorney's Name and Address: COURT USE ONLY Case Number: Phone Number: FAX Number: E-mail: Atty. Reg. #: Division: Courtroom: PROTEST TO REVISED ABANDONMENT LIST Any person who wishes to protest the inclusion of any water right in a decennial abandonment list after its revision by the division engineer shall file a written protest with the water clerk and the division engineer. All such protests to the decennial abandonment list shall be filed not later than June 30, 2012, or the respective tenth anniversary thereafter. Such protest shall set forth in detail the factual and legal basis therefor. §37-92-401(5), Colo. Rev. Stat. See instructions for all Colorado water court divisions for the appropriate filing fee. 1. Name, mailing address, email address and home telephone number of Protestant/Owner: Name of Protestant/Owner Mailing Address Email address Home Phone Number 2. Describe the Water Right: A. Name of Structure: B. Date of Original Decree: Case No: Court: C. Location and legal description: (PLSS) (include perpendicular distances from section lines, and indicate ¼ ¼, 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 ½ 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. In areas having generally recognized street addresses, include street address, and if applicable, the lot, block, and subdivision: Preferred Legal Description (PLSS): Preferred Legal Description: County ______1/4 of the _____1/4 Section Township _______ N or S Range _______ E or W Principal Meridian JDF 304W R 10/11 PROTEST TO REVISED ABANDONMENT LIST Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Distance from section lines (section lines are typically not property lines) ____________ Feet from N S and _____________ Feet from E W Street Address:_______________________________________________________________________ Subdivision: Lot Block OR, in the alternative, if PLSS is not available. GPS location information in UTM format. Required settings for GPS units are as follows: Format must be UTM; Zone must be 12 or13; Units must be Meters; Datum must be NAD83, and Units must be set to true North. Alternative Description (UTM): Were points averaged? Northing ___________________ Easting _____________________ Yes No D. Source of water: E. Decreed use or uses: F. Appropriation Date: Zone 12 Zone 13 Decreed Amount: G. Amount listed as having been abandoned: H. Former District Number and Page Number where listed on Abandonment List: 3. State factual and legal basis for this Protest: 4. Remarks: _______________________________________________________________________________________ ______________________________________ Signature of Attorney (if applicable) Date JDF 304W R 10/11 PROTEST TO REVISED ABANDONMENT LIST Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com VERIFICATION AND ACKNOWLEDGMENT OF PERSON HAVING KNOWLEDGE OF THE FACTS STATED IN THIS PROTEST Being first duly sworn, I hereby state that I have read this document, that I have personal knowledge of the facts stated and verify its contents to the best of my knowledge, information, and belief. ____________________________________________ Signature Date The foregoing instrument was acknowledged before me in the County of ________________, State of Colorado, this ____day of ____________, 20___, by the person whose signature appears above. My Commission Expires: ________________ _____________________________________________ Notary Public/Deputy Clerk The person signing this verification is: Protestant Engineer Other (describe) ____________________ Verifications of other persons having knowledge of the facts may be attached to this Protest. CERTIFICATE OF MAILING I certify that I mailed a copy of the foregoing Protest to Abandonment List to (insert Division Engineer's name and address): __________________________________________________________________________________ on _______________________ (date), postage prepaid. ______________________________________ Protestant JDF 304W R 10/11 PROTEST TO REVISED ABANDONMENT LIST Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com