Res 2012-039 - Laserfiche WebLink

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Part III - Transfer Information A. Type of Transaction: 8 Lease ❑ Sub -Lease B. Duration of lease: from January 1, 2012 to December 31, 2012 C. Type of Transfer (check all applicable): ❑ Right to Withdraw 8 Change of Point of Withdrawal ❑ Addition of Point of Wtihdrawal A Change of Purpose of Use Change of Place of Use ❑ Other D. Total Transfer Amount: 300 Acre -Feet /Year If Irrigation, please specify amount being transferred as follows: Acre- Feet/Year of "Base Irrigation Groundwater" withdrawal rights Acre- Feet/Year of "Unrestricted Irrigation Groundwater" withdrawal rights E. Transfer Price: $ NSA /acre -foot (optional) F. Notes to staff regarding this transfer: Part IV — Certification Transferor's Certification: ** *'NOTE: DO NOT SIGN ON THIS PAGE - SIGNATURE PAGES FOLLOW!! I hereby certify that the information given herein this application is true and accurate to the best of my knowledge and belief. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXXXX Printed Name of Transferor or Agent STATE OF TEXAS COUNTY OF Signature of Transferor or Agent Subscribed and sworn before me this day of '20, XXXXXXXXXXXXXXXXXXXXXXXXX Notary Public's Signature Date Commission Expires: Transferee's Certification: I hereby certify that the information given herein this application is true and accurate to the best of my knowledge and belief. XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXXXXXXXXX Printed Name of Transferee or Agent Signature of Transferee or Agent STATE OF TEXAS COUNTY OF Subscribed and sworn before me this day of 20 Notary Public's Signature Date Commission Expires: If you need assistance, please contact the Docket Coordinator at (210) 222 -2204 or (800) 292 -1047.