Lease Renewal Form - Oregon
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1
2
3February 13, 2012
Application for
State of Oregon
Instream Lease Renewal
Water Resources Department
725 Summer Street NE, Suite A
Salem, Oregon 97301-1266
(503) 986-0900
A summary of review criteria and procedures that are generally applicable to these applications is available at
The undersigned entered into Instream Lease Number IL-
involving Water Right
Certificate(s)
on
, which terminated on
.
The undersigned Lessor and Lessee, parties to the original lease, hereby request that Lease
Number IL-
be renewed. Lessor and Lessee warrant that, to the best of their
knowledge, circumstances have not changed and all matters involved with or affected by the
instream lease and the subject water right(s) remain as they were when the lease was first entered
into, including but not limited to water right holder interest, the acres from which the right is
leased, and the public instream benefit provided as a result of this instream lease.
The terms and conditions of instream lease IL-
are hereby incorporated by reference in
their entirety, with the following exception(s):
The term of the lease shall commence on
(not before execution by the
parties) and continue through
.
CREP. Are some or all of the lands being leased part of a Conservation Reserve Enhancement
Program?
Yes
No
or other Federal Program:
Fees. Pursuant to ORS 536.050, the following fee is included:
$100 for an instream lease renewal application.
Lessor Signature: _______________________________
Date: ___________________
Print Name:
City, State, Zip:
Telephone Number:
E-mail address**:
Lessor Signature: _______________________________
Date: ___________________
Print Name:
City, State, Zip:
Telephone Number:
E-mail address**:
For additional Lessors, add additional page using the above format.
Lessee Signature: _______________________________
Date: _____________
Lessee Organization:
Phone Number:
E-mail address**:
**BY PROVIDING AN E-MAIL ADDRESS, CONSENT IS GIVEN TO RECEIVE ALL CORRESPONDENCE FROM THE
DEPARTMENT ELECTRONICALLY. COPIES OF THE FINAL ORDER DOCUMENTS WILL ALSO BE MAILED.
Instream Lease Renewal Form / 1
TACS
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