Form Wr-21-Mrg - Declaration Of Ownership Of Water Right - New Mexico Office Of The State Engineer Page 2

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Fee: _____ Receipt No. HC 1-___________
File Number: _______________
NEW MEXICO OFFICE OF THE STATE ENGINEER
DECLARATION OF OWNERSHIP OF WATER RIGHT OF SURFACE WATERS
PERFECTED PRIOR TO MARCH 19, 1907 IN THE MIDDLE RIO GRANDE CONSERVANCY DISTRICT
5. PURPOSE OF USE
Irrigation: ____
If any other purpose, specify: ___________________
6. WATER WAS FIRST APPLIED TO BENEFICIAL USE ON: ___ ____________________________
and since that time has been used fully and continuously for the above
described purpose(s) except as follows:
7. ADDITIONAL STATEMENTS OR EXPLANATIONS:
Note: A declaration may be accompanied by a map prepared pursuant to 19.26.2.26 NMAC and may
be accompanied by deeds, survey plats, affidavits and other evidence tending to substantiate
the claim.
ACKNOWLEDGEMENT FOR NATURAL PERSONS
(I, We) ____________________________________________________ affirm that the
(Please Print)
foregoing statements are true to the best of my knowledge and belief.
_____________________________________ _____________________________________.
Declarant Signature
Declarant Signature
N O T A R Y
This instrument was acknowledged before me this ____ day of _______________,
A.D., ____, By __________________________;
_______________________________.
Name of Declarant(s)
Name of Declarant(s)
My commission expires _______________
__________________________________
Notary Public
ACCEPTANCE OF STATE ENGINEER
This Declaration form is hereby accepted for filing in accordance with NMSA-1978
(1985), as amended. The acceptance by the State Engineer Office does not
constitute validation of the right claimed.
___________________________________________________
File Number: _______________
Trn Number: _______________
(Revised April 2016)
Form: wr-21-mrg

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