Instructions for Addendum DNR SW Form 200-a - District Transfer Applications

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a.
The applicant may request the Department to calculate HCU using the adopted method to
determine the amount of the appropriation subject to the transfer.
b.
The applicant may provide credible historic consumptive use calculations using any scientific
method they deem credible, but the Department reserves the right to adjust the transferrable
amount.
c.
If the applicant has a requested HCU, it should be entered in item 9. The Department reserves the
right to adjust the transferrable amount.
9.
Acknowledgement by Organization certifies that the information contained in this form and all attachments
is true and accurate, that all attachments have been initialed by the signatory, that the organization agrees to
pay for the costs associated with publication of legal notice, filing in the County Register of Deeds, and if
necessary a portion of hearing costs.
for as many
(No Item Number) Attach Addendum form: SW Form # 200-A
landowners and tracts as necessary.
This addendum form is specific for SW Form # 200.
See the following instructions for the addendum form.
Instruction Sheet for District Transfer Applications
Addendum SW Form # 200-A
Addendum Form Item Number:
1.
a.
List the number of acres in each quarter-quarter currently under the appropriation subject to this
transfer(appurtenant), or acres in each quarter-quarter from which the appropriation was
relinquished and that will be subject to this transfer (non-appurtenant).
Appurtenant: The Addendum form SW Form # 200-A, should be completed in its
entirety for each landowner, including the landowner signature(s), mortgage holder
information, list of land and history of use. Attach as many addendum forms as needed to
provide complete information for the appurtenant (portion of) the appropriation subject to
the transfer. Attach aerial photography clearly marked to show the above-listed land that
is subject to the transfer
a.
The applicant may request the Department to calculate HCU using the adopted method to
determine the amount of the appropriation subject to the transfer.
b.
The applicant may provide credible historic consumptive use calculations using any scientific
method they deem credible, but the Department reserves the right to adjust the transferrable
amount.
c.
If the applicant has a requested HCU, it should be entered in item 9. The Department reserves the
right to adjust the transferrable amount.
9.
Acknowledgement by Organization certifies that the information contained in this form and all attachments
is true and accurate, that all attachments have been initialed by the signatory, that the organization agrees to
pay for the costs associated with publication of legal notice, filing in the County Register of Deeds, and if
necessary a portion of hearing costs.
for as many
(No Item Number) Attach Addendum form: SW Form # 200-A
landowners and tracts as necessary.
This addendum form is specific for SW Form # 200.
See the following instructions for the addendum form.
Instruction Sheet for District Transfer Applications
Addendum SW Form # 200-A
Addendum Form Item Number:
1.
a.
List the number of acres in each quarter-quarter currently under the appropriation subject to this
transfer(appurtenant), or acres in each quarter-quarter from which the appropriation was
relinquished and that will be subject to this transfer (non-appurtenant).
Appurtenant: The Addendum form SW Form # 200-A, should be completed in its
entirety for each landowner, including the landowner signature(s), mortgage holder
information, list of land and history of use. Attach as many addendum forms as needed to
provide complete information for the appurtenant (portion of) the appropriation subject to
the transfer. Attach aerial photography clearly marked to show the above-listed land that
is subject to the transfer
Non-Appurtenant: List the legal descriptions of the land to which the appropriation was
appurtenant to prior to cancellation order date stated in Item 7 of the SW Form # 200 and
the history of use for the most recent 10 years for (the portion of) the non-appurtenant
appropriation subject to this transfer. The list of land and history of each tract may be
submitted on the Addendum form, SW Form # 200-A but the landowner signature and
mortgage holder information may be omitted. The aerial photograph may be omitted for
nonappurtenant appropriations.
b.
Indicate the source of any water used on the described land. Circle all that apply, i.e. surface
water, groundwater and other; if “other” is circled, then describe the source, such as lagoon water.
2.
List the history of water use for the most recent ten years for the tracts listed above. This history is
necessary for calculating the Historic Consumptive Use (HCU). Even if the portion of the appropriation
being transferred is longer appurtenant, the history is required.
a.
“Acres irrigated” means the land subject to this transfer irrigated by surface water, comingled with
groundwater, or other source. The land listed in item 1a. and shown on the marked aerial
photograph must correspond.
b.
If groundwater or another source was used for irrigation on any portion of the land listed in this
transfer application, please refer to the “Consumptive Use Calculation Worksheet” for additional
information required regarding water use.
c.
List on each line an estimate (in percent) of each crop type for that year. For example: 2007,
diverted water for 60 days, 100 acres irrigated, 20% Alfalfa, 40% Corn, 40% Beans, maximum
pump 800 gpm, 212 acrefeet/ yr.
The following items must be completed if the appropriation is currently appurtenant:
3.
List all mortgage or deed of trust holders. Pursuant to Nebraska Revised Statutes § 46-291-(2), the
Department is required to notify each holder of a mortgage, trust deed, or other equivalent consensual
security interest that is identified by the applicant/landowner, that this transfer application has been filed.
4.
Current landowner must consent to the transfer by signing and dating the form. The applicant should verify
using all readily available sources as to the authority of the person signing as owner, or having a legal
interest, in the tracts of land subject to this transfer.
a.
If landowner is a corporation, indicate the capacity of the person signing the form; for example,
president. Additional contact information may be required.
b.
If landowner is a trust, list the name of the trust and the capacity of the person signing for the trust.
c.
Persons signing as attorney-in-fact (power of attorney) shall submit a copy of the document
granting power of attorney, OR:
d.
Persons signing as the personal representative shall submit a copy of the document granting the
authority to act as the owner’s agent.

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