Form 6417 Assignment of Statement of Claimant - General Adjudication of All Rights to Use Water in the Little Colorado River System and Source - Apache County, Arizona

Form 6417 or the "Assignment Of Statement Of Claimant - General Adjudication Of All Rights To Use Water In The Little Colorado River System And Source" is a form issued by the Arizona Department of Water Resources.

The form was last revised in July 1, 2016 and is available for digital filing. Download an up-to-date Form 6417 in PDF-format down below or look it up on the Arizona Department of Water Resources Forms website.

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IN THE SUPERIOR COURT OF THE STATE OF ARIZONA
IN AND FOR THE COUNTY OF APACHE
IN RE THE GENERAL ADJUDICATION
NO. 6417
OF ALL RIGHTS TO USE WATER IN THE
LITTLE COLORADO RIVER SYSTEM
ASSIGNMENT OF STATEMENT OF
AND SOURCE
CLAIMANT
This form is to be used to notify the Superior Court of Apache County of any change in ownership of land
upon which a claim for a water right was made on a statement of claimant form filed in the General
Adjudication of the Little Colorado River System and Source. This form may also be used to notify the
Court of any change in ownership of a water right which is not attached or appurtenant to land or which
has been transferred from one parcel of land to another.
Both sides of this form are to be completed in accordance with the instructions below. All signatures are to
be verified by a notary public.
Mail the original completed form to:
Arizona Department of Water Resources
P.O. Box 36020
Phoenix, Arizona 85067-6020
1-866-246-1414
www.azwater.gov
GENERAL INSTRUCTIONS
Please attach to this form a copy of the duly recorded deed, a copy of the County Assessor’s tax parcel
notice or other documentation which evidences change of ownership of the land or of a water right to which
statement(s) of claimant applies.
Two or more statements of claimant may be assigned on this form only if the assignor(s)/seller(s) are
identical on all statements of claimant and the assignee(s)/buyer(s) are identical on all statements of
claimant. If a statement of claimant is subdivided to two or more separate assignees/buyers, an assignment
form must be completed for each of the assignees/buyers. If more space is needed, attach a separate sheet.
This assignment form must be signed by all assignee(s)/buyer(s) and all assignor(s)/seller(s), and the current
address and telephone number of each party must be furnished. If there are more than two assignees or
assignors, the name, address, telephone number and signature of each additional assignee or assignor should
be attached on a separate sheet.
The undersigned parties hereby notify the Superior Court of Apache County of the assignment of
the following statement(s) of claimant:
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
Rev. 07/16
IN THE SUPERIOR COURT OF THE STATE OF ARIZONA
IN AND FOR THE COUNTY OF APACHE
IN RE THE GENERAL ADJUDICATION
NO. 6417
OF ALL RIGHTS TO USE WATER IN THE
LITTLE COLORADO RIVER SYSTEM
ASSIGNMENT OF STATEMENT OF
AND SOURCE
CLAIMANT
This form is to be used to notify the Superior Court of Apache County of any change in ownership of land
upon which a claim for a water right was made on a statement of claimant form filed in the General
Adjudication of the Little Colorado River System and Source. This form may also be used to notify the
Court of any change in ownership of a water right which is not attached or appurtenant to land or which
has been transferred from one parcel of land to another.
Both sides of this form are to be completed in accordance with the instructions below. All signatures are to
be verified by a notary public.
Mail the original completed form to:
Arizona Department of Water Resources
P.O. Box 36020
Phoenix, Arizona 85067-6020
1-866-246-1414
www.azwater.gov
GENERAL INSTRUCTIONS
Please attach to this form a copy of the duly recorded deed, a copy of the County Assessor’s tax parcel
notice or other documentation which evidences change of ownership of the land or of a water right to which
statement(s) of claimant applies.
Two or more statements of claimant may be assigned on this form only if the assignor(s)/seller(s) are
identical on all statements of claimant and the assignee(s)/buyer(s) are identical on all statements of
claimant. If a statement of claimant is subdivided to two or more separate assignees/buyers, an assignment
form must be completed for each of the assignees/buyers. If more space is needed, attach a separate sheet.
This assignment form must be signed by all assignee(s)/buyer(s) and all assignor(s)/seller(s), and the current
address and telephone number of each party must be furnished. If there are more than two assignees or
assignors, the name, address, telephone number and signature of each additional assignee or assignor should
be attached on a separate sheet.
The undersigned parties hereby notify the Superior Court of Apache County of the assignment of
the following statement(s) of claimant:
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
39-
filed in the _____________________ Little Colorado River Watershed.
Rev. 07/16
BUYER(S)/ ASSIGNEE(S):
SELLER(S)/ASSIGNOR(S):
Name(s) (printed or typed)
Name(s) (printed or typed)
Address
Address
(
)
(
)
Telephone
Telephone
Signature
Signature
Signature
Signature
STATE OF ARIZONA
)
STATE OF ARIZONA
)
)ss.
)ss.
County of
County of
)
)
The foregoing instrument was
The foregoing instrument was
acknowledged and signed before
acknowledged and signed before
me this
day of
me this
day of
, 20
,
, 20
,
by
by
Notary Public
Notary Public
My commission expires:
My commission expires:
Rev. 07/16

Download Form 6417 Assignment of Statement of Claimant - General Adjudication of All Rights to Use Water in the Little Colorado River System and Source - Apache County, Arizona

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