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A. Type of Transaction: <br />8 Lease ❑ Sub -Lease <br />B. Duration of lease: <br />from Jan 1, 2013 to December 31, 2013 <br />❑ For leases with a term of one year or less, check here if you would like this application to serve as the memorandum of lease required <br />under § 711.330 of the EAA rules. If not, please attach a separate memorandum of lease or the executed lease agreement. <br />Please note, a copy of the recorded lease agreement or recorded memorandum of lease containing the official county clerk <br />document stamp is required for leases with a term greater than one year. <br />C. Type of Transfer (check all applicable): <br />8 Right to Withdraw Change of Point of Withdrawal ❑ Addition of Point of Wtihdrawal <br />8 Change of Purpose of Use Change of Place of Use ❑ Other <br />D. Total Transfer Amount: 1000 Acre -Feet /Year <br />If Irrigation, please specify amount being transferred as follows: <br />Acre- Feet/Year of "Base Irrigation Groundwater" withdrawal rights <br />Acre- Feet/Year of "Unrestricted Irrigation Groundwater" withdrawal rights <br />E. Transfer Price: $ /acre -foot (optional) <br />F. Notes to staff regarding this transfer: <br />Transferor's Certification: ***NOTE: DO NOT SIGN ON THIS PAGE-SIGNATURE PAGES FOLLOW! ! <br />I hereby certify that the information given herein this application is true and accurate to the best of my knowledge and belief. <br />XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXXXX <br />Printed Name of Transferor or Agent Signature of Transferor or Agent <br />STATE OF TEXAS <br />COUNTY OF <br />Subscribed and sworn before me this <br />day of 20 <br />XXXXXXXXXXXXXXXXXXXXXXXXXXXX <br />xxxxxxxxxxxxxxxxxxXXXXXXXXXX <br />Notary Public's Signature <br />Date Commission Expires: <br />Transferee's Certification: <br />I hereby certify that the information given herein this application is true anXXXXXS:XXXS:XX�XXXX <br />Printed Name of Transferee or Agent <br />STATE OF TEXAS <br />COUNTY OF <br />Subscribed and sworn before me this <br />XXXXXXXXXXXXXXXXXXXXXXXXXXX <br />Signature of Transferee or Agent <br />day of 20 <br />Notary Public's Signature <br />Date Commission Expires: <br />If you need assistance, please contact the Permits Team at (210) 222 -2204 or (800) 292 -1047. <br />Revised 0412612012 <br />