File Number: (For OSE Use Only) NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE LOCATION OF WELL 1. WATER RIGHT OWNER Name: 7nrrn Ranch Contact: Brice Gordon Address: 49 Zorro Ranch City: Stanley 2. PURPOSE OF USE Work Phone: Home Phone: State: NM Zip: 87056 Domestic: X Livestock: X Irrigation: X Municipal: Industrial: Commercial: Other (specify): Ranch Related Specific use: 3. QUANTITY Consumptive Use: acre-feet per annum Diversion Amount: 68 acre-feet per annum 4. PLACE OF USE 24 acres of land described as follows: Subdivision of Section Section Township Range Acres (District or (Map No.) (Tract No.) Hydrographic Survey) SW 1/4 SW 1/4 NE 114 1211_ QE SF 114 22_ 1.2N_ 20_ Who is the owner of the land? Jeffrey Fpctein Trustee Do Not Write Below This Line File Number: Trn Number: Form: wr-06 page 1 of 4 EFTA01222825