Form Wr-15 - Notice Of Intention To Make Formal Application For Permit To Appropriate Surface Water Page 2

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File Number: _______________
(For OSE Use Only)
NEW MEXICO OFFICE OF THE STATE ENGINEER
NOTICE OF INTENTION TO MAKE FORMAL
APPLICATION FOR PERMIT TO APPROPRIATE SURFACE WATER
5. PLACE OF USE
__________
acres of land described as follows:
Subdivision of Section
Section
Township
Range
Acres
(District or
(Map No.)
(Tract No.)
Hydrographic Survey)
______________________________
_____
_____
_____
_____
______________________________
_____
_____
_____
_____
______________________________
_____
_____
_____
_____
______________________________
_____
_____
_____
_____
______________________________
_____
_____
_____
_____
Who is the owner of the land? ______________________________________________
6. ADDITIONAL STATEMENTS OR EXPLANATIONS:
ACKNOWLEDGEMENT
(I, We) ____________________________________________________ affirm that the
(Please Print)
foregoing statements are true to the best of (my, our) knowledge and belief.
_____________________________________ _____________________________________.
Applicant Signature
Applicant Signature
__________________________Do Not Write Below This Line________________________
File Number: _______________
Trn Number: _______________
Form: wr-15
page 2 of 2

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