"Affirmation of Cancellation Form" - Nebraska

Affirmation of Cancellation Form is a legal document that was released by the Nebraska Department of Natural Resources - a government authority operating within Nebraska.

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AFFIRMATION OF CANCELLATION
I hereby affirm that I am not contesting the Department of Natural Resources’
preliminary determination that the __________Quarter of Section _____________,
Township ____________, Range _____________, in ____________________ County has not been
irrigated in the last __________ years with water authorized by appropriation A-
______________.
I agree that in accordance with Neb. Rev. Stat. §46-229.02(4)(Reissue
2004) the Department may cancel my right to irrigate such lands and that portion of water
appropriation A-_____________ attached to such lands.
___________________________________________
_____________
Name
Date
STATE OF NEBRASKA
)
)
COUNTY OF ________________
)
On _____________________, before me _______________________, a notary public,
Month, Day, Year
Notary's Name
personally came ________________________ as owner of the land described herein, and
being duly sworn, affirms the above as true and accurate.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal at
___________________________, ______________________ County, Nebraska, this _____ day
of _________________________, _______.
___________________________________
Notary Public
AFFIRMATION OF CANCELLATION
I hereby affirm that I am not contesting the Department of Natural Resources’
preliminary determination that the __________Quarter of Section _____________,
Township ____________, Range _____________, in ____________________ County has not been
irrigated in the last __________ years with water authorized by appropriation A-
______________.
I agree that in accordance with Neb. Rev. Stat. §46-229.02(4)(Reissue
2004) the Department may cancel my right to irrigate such lands and that portion of water
appropriation A-_____________ attached to such lands.
___________________________________________
_____________
Name
Date
STATE OF NEBRASKA
)
)
COUNTY OF ________________
)
On _____________________, before me _______________________, a notary public,
Month, Day, Year
Notary's Name
personally came ________________________ as owner of the land described herein, and
being duly sworn, affirms the above as true and accurate.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal at
___________________________, ______________________ County, Nebraska, this _____ day
of _________________________, _______.
___________________________________
Notary Public