Application For Water Right Transfer Evidence Of Use Affidavit Form - Oregon Water Resources Department
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1
2Oregon Water Resources Department
Application for Water Right
725 Summer Street NE, Suite A
Salem, Oregon 97301-1266
Transfer
(503) 986-0900
Evidence of Use Affidavit
Please print legibly or type. Be as specific as possible. Attach additional pages if you need more spacing.
Supporting documentation must be attached.
State of Oregon
)
)
ss
County of
)
__________________________
I, _______________________________, in my capacity as ________________________________,
mailing address ____________________________________________________________________
telephone number (___)_______________, being first duly sworn depose and say:
1. My knowledge of the exercise or status of the water right is based on (check one):
Personal observation
Professional expertise
2. I attest that:
Water was used during the previous five years on the entire place of use for
Certificate # _________ ; OR
My knowledge is specific to the use of water at the following locations within the last five years:
Gov’t Lot
Acres
Certificate #
Township
Range
Mer
Sec
¼ ¼
or DLC
(if applicable)
OR
Confirming Certificate # _____________ has been issued within the past five years; OR
Part or all of the water right was leased instream at some time within the last five years. The
instream lease number is: _____________________ (Note: If the entire right proposed for
transfer was not leased, additional evidence of use is needed for the portion not leased instream.); OR
The water right is not subject to forfeiture and documentation that a presumption of forfeiture for
non-use would be rebutted under ORS 540.610(2) is attached.
Water has been used at the actual current point of diversion or appropriation for more than
10 years for Certificate # ______________(For Historic POD/POA Transfers)
(continues on reverse side)
Revised 2/5/2010
Evidence of Use Affidavit - Page 1 of 2
FS
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