File No. NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE AN EXISTING WATER RIGHT (Non 72-12-1) (check applicable boxes): For fees see State Engineer website: http://wvAv.ose.state.nm.us/ 0 Change Purpose of Use 0 Groundwater 0 Surface Water 5 Change Place of Use 0 Additional Groundwater Point of Diversion (POD) 0 Additional Surface Water Point of Diversion (POD) 01 Change Point of Diversion (POD): From: 0 Groundwater 0 Surface Water To: 0 Groundwater • Surface Water • Groundwater • Surface Water M Temporary Change, NMSA 1978, § 72-12-7(B) Requested Start Date: Requested End Date: (Not to Exceed 3 ac-ft in One Year) ID Water Use Lease, NMSA 1978, §§ 72-6-1 to-7 Requested Start Date: Requested End Date: 1. APPLICANT(S) (Required) Note: water-right owner must be listed as an applicant. Name: Cypress, Inc. Name: Contact or Agent: Brice M. Gordon check here if Agent 0 Contact or Agent: check here if Agent 0 Mailing Address: 49 Zorro Ranch Road Mailing Address: City: Stanley City: State: NM Zip Code: 87056 State: Zip Code: 0 Home 0 Cell Phone: Phone (Work): El Home • Cell E-mail (optional): E-mail (optional): 2. CURRENT OSE FILE INFORMATION (Required) OSE File No(s): E-7871 ET ALS. Priority Date (if known): 11/22/2000 Subfile/Cause No. (if applicable): 3. CURRENT PURPOSE OF USE AND AMOUNT OF WATER (Required) El Domestic El Livestock El Irrigation 0 Municipal 0 Industrial 0 Commercial 0 Other Use (specify): Ranch Related Describe a specific use If applicable (i.e. sand & gravel washing, dairy etc): Amount of Water (acre-feet per annum): If more details are needed, type "See Comments" in "Other" field below, and explain in Additional Statements Section. Diversion: 68 a/f Consumptive Use: 68 a/f Other (include units): FOR OSE INTERNAL USE Application for Permit Form wr-06, Rev 9/26/12 File No.: Tm. No.: Receipt No.: Trans Description (optional): Sub-Basin: PCW/LOG Due Date: