EFTA00298500.pdf

File No. NEW MEXICO OFFICE OF THE STATE ENGINEER CHANGE OF OWNERSHIP OF 72-12-1 PERMIT FOR (check one) hamlilt Wins Cianniiiii Individual El Corporation D 1. OWNER OF RECORD (Seller) Name: Zorro Trust Name: Phone: Home M Cell Phone: 9 Home • Cell Phone (Work): Phone (Work): a. Owner of Record File No: E-05509 b. Sub-file No.: c. Cause No.: 2. NEW OWNER (Buyer) Note: If more owners need to be listed, attach a separate sheet. Attached? 0 Yes Name: Cypress, Inc. Name: Contact or Agent: check here if Agent MI Contact or Agent: check here if Agent • Jeffrey Epstein Mailing Address: 9100 HavensIght, Pon of Sale, Suite 15/16 Mailing Address: City: St. Thomas City: State: VI Zip Code: 00802 State: Zip Code: Phone: M Home E Cell Phone: • Home • Cell Phone (Work): Phone (Work): E-mail (optional): E-mail (optional): Required: Submit warranty deed(s) or other Instrument(s) of conveyance properly recorded with the county clerk's office. 3. AMOUNT CONVEYED Amount of Water (acre-feet per annum): 3.000 acre-feet 4. LIST ALL KNOWN POINT(S) OF DIVERSION (POD) FOR THE 72-12-1 PERMIT CONVEYED OSE POD No. Subdivision Section Township Range E-5509 SE 1/4 SE 114 22 12N 9E FOR OSE INTERNAL USE Change of Ownership. Form wr•02d. Revised 8/25/11 File Number: Tm Number: Trans Description (optional): SitBasin: Page I of 2 EFTA00298500  5. ADDITIONAL STATEMENTS OR EXPLANATIONS ACKNOWLEDGEMENT FOR INDIVIDUAL I, We (name of owner(s)) Print Name(s) affirm that the foregoing statements are true to the best of (my. our) knowledge and belief. Signature Signature State of ss. County of This instrument was acknowledged before me this day of M.. 20 , by (name of owner(s)): Notary Public: My commission expires: ACKNOWLEDGEMENT FOR CORPORATION I. We (name of owner(s)) 7orro Trust Print Name(s) affirm that the foregoing statements are true to the best of (my, our) knowledge and belief. Officer Signature Officer Signature State of ss. County of This instrument was acknowledged before me this day of December M.. 20 11 , by the following on behalf of said corporation. Name of Officer: Jeffrey Epstein Title of Officer: Trustee Name of Corporation Acknowledging: Zorro 'Must State of Corporation: Ohio Notary Public: My commission expires: FOR OSE INTERNAL USE Change of Ownership. Form wr•02d. Revised 8/25/11 File Number: I Tm Number: Trans Description (optional): SWBasin: Page 2 of 2 EFTA00298501 FOR OSE INTERNAL USE Change of Ownership. Form wr•02d. Revised 8/25/11 File Number: Tm Number: Trans Description (optional): Sub•Basin: Page 3 of 2 EFTA00298502  CHANGE OF OWNERSHIP INSTRUCTIONS a. The "Owner of Record- of a water right is the current owner recorded in the State Engineer Office. b. This form shall be completed by the new owner and shall be accompanied by a warranty deed or other instrument of conveyance that has been properly recorded with the county clerk's office. c. A separate Change of Ownership of Water Right form shall be filed for each water right recorded in the State Engineer Office by Permit. License. Declaration or Court Adjudication. d. This form shall be filed in triplicate (3) and must be accompanied by the proper filing fee. Each form must have an original signature and each must be properly notarized. A notary public is available in each water right district office at no cost. e. An original will be forwarded to the new owner with instructions to file it with the county clerk in the county in which the water right is located. Acceptance of the form for filing by the State Engineer does not constitute verification of the right conveyed. LINE BY LINE INSTRUCTIONS 1. Enter the name of the current owner on record with the OSE (required). a. Enter the file number currently on record with the OSE. b. Enter the sub file number if one has been assigned as part of completed or on-going water rights adjudication. c. Enter the Cause Number of the water rights adjudication. if applicable. 2. Enter name and address of the new owner (required). If the person to be contacted concerning this right is other than the new owner enter contact person's name. The phone number of new owner or contact person is optional. 3. Enter the amount conveyed in acre-feet per annum. 4. Specify all points of diversion that, to your knowledge, serve this right. If an entry is not applicable. enter NA. Enter the OSE POD Number and legal description of each well. 5. Provide any additional statements that might help to clarify this water right transfer. Assistance in completing this form is available. and the form may be filed at the State Engineer Office in Santa Fe and the District Offices located as follows: District 1 District 4 District 7 5550 San Antonio Drive NE 1680 Hickory Loop. Suite J 301 East e Street Albuquerque. NM 87109-4127 Las Cruces. NM 88005-6598 Box 481 Phone # 505-383-4000 Phone # 575-524-6161 Cimarron, NM 87714 Phone # 575-376-2918 District 2 District 5 1900 West Second Street. 100 Gossett Drive. Suite A Roswell. NM 88201-1712 Aztec. NM 87410 Phone # 575-622-6521 Phone # 505-334-4571 District 3 District 6 301 South Tin. M. Box 844 407 Galisteo Street Deming. NM 88031-0844 Room 102. Bataan Memorial Building Phone # 575-546-2851 M. Box 25102 Santa Fe. NM 87504-5102 Phone # 505-827-6120 EFTA00298503