NeDNR SW Form 090 "Relinquishment of a Surface Water Appropriation by the Landowner" - Nebraska

What Is NeDNR SW Form 090?

This is a legal form that was released by the Nebraska Department of Natural Resources (Surface Water) - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2020;
  • The latest edition provided by the Nebraska Department of Natural Resources (Surface Water);
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of NeDNR SW Form 090 by clicking the link below or browse more documents and templates provided by the Nebraska Department of Natural Resources (Surface Water).

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Download NeDNR SW Form 090 "Relinquishment of a Surface Water Appropriation by the Landowner" - Nebraska

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NeDNR SW-090
STATE OF NEBRASKA
November 2020
DEPARTMENT OF NATURAL RESOURCES
RELINQUISHMENT OF A SURFACE WATER APPROPRIATION BY THE LANDOWNER
1. Appropriator of Record
FOR DEPARTMENT USE ONLY
Name: ______________________________________________________________
Filed in the office of the Dept. of Natural Resources
at ____:____ on _____________________, 20____
Address 1: __________________________________________________________
Address 2: __________________________________________________________
Modification REL-___________________________
City & State: ________________________________________________________
SW Permit: ________________________________
Zip Code: _______________________
Phone Number: (
)______-_________
RightD: ____________________________________
Cell Phone: (
)______-_________
Water Division: _____________________________
E-Mail Address: ______________________________________________________
2. Surface Water Appropriation Details
Appropriation (permit number) to be relinquished: _____________________ Priority Date: _____________________________
Source of Water: __________________________________________________________________________________________
3. Relinquishment Information
This is a
Full
Partial relinquishment of the surface water appropriation listed above.
Is this relinquishment conditional based on other circumstances?
Yes
No
(Approval of new permit or transfer, end of a contract, etc.)
If yes, please explain: ______________________________________________________________________________________
_____________________________________________________________________________________
4. Location of Appropriation Being Relinquished
a) Enter Section, Township, Range and Range Direction.
b) Enter the number of acres currently appurtenant that is being relinquished from each quarter-quarter section.
NW¼ 
NE¼ 
SW¼ 
SE¼ 
Total 
NW¼  NE¼  SW¼  SE¼  NW¼  NE¼  SW¼  SE¼  NW¼  NE¼  SW¼  SE¼  NW¼  NE¼  SW¼  SE¼ 
Acres 
Section Township Range Direction
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
Total Acres Relinquished:  
0.0
Landowner Signatures
5.
I/We certify that I am/We are the owner(s) of the lands listed above, I/We do hereby relinquish all claims to the right to divert
water and apply it to the property described above in accordance with the appropriation listed above.
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
No Filing Fee Required
Submit this form to:
Nebraska Department of Natural Resources
301 Centennial Mall South
PO Box 94676
Lincoln, Nebraska 68509
(402) 471-2363
NeDNR SW-090
STATE OF NEBRASKA
November 2020
DEPARTMENT OF NATURAL RESOURCES
RELINQUISHMENT OF A SURFACE WATER APPROPRIATION BY THE LANDOWNER
1. Appropriator of Record
FOR DEPARTMENT USE ONLY
Name: ______________________________________________________________
Filed in the office of the Dept. of Natural Resources
at ____:____ on _____________________, 20____
Address 1: __________________________________________________________
Address 2: __________________________________________________________
Modification REL-___________________________
City & State: ________________________________________________________
SW Permit: ________________________________
Zip Code: _______________________
Phone Number: (
)______-_________
RightD: ____________________________________
Cell Phone: (
)______-_________
Water Division: _____________________________
E-Mail Address: ______________________________________________________
2. Surface Water Appropriation Details
Appropriation (permit number) to be relinquished: _____________________ Priority Date: _____________________________
Source of Water: __________________________________________________________________________________________
3. Relinquishment Information
This is a
Full
Partial relinquishment of the surface water appropriation listed above.
Is this relinquishment conditional based on other circumstances?
Yes
No
(Approval of new permit or transfer, end of a contract, etc.)
If yes, please explain: ______________________________________________________________________________________
_____________________________________________________________________________________
4. Location of Appropriation Being Relinquished
a) Enter Section, Township, Range and Range Direction.
b) Enter the number of acres currently appurtenant that is being relinquished from each quarter-quarter section.
NW¼ 
NE¼ 
SW¼ 
SE¼ 
Total 
NW¼  NE¼  SW¼  SE¼  NW¼  NE¼  SW¼  SE¼  NW¼  NE¼  SW¼  SE¼  NW¼  NE¼  SW¼  SE¼ 
Acres 
Section Township Range Direction
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
   East 
0.0
   West
Total Acres Relinquished:  
0.0
Landowner Signatures
5.
I/We certify that I am/We are the owner(s) of the lands listed above, I/We do hereby relinquish all claims to the right to divert
water and apply it to the property described above in accordance with the appropriation listed above.
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
_____________
________________________________________________
____________________________________
Date
Signature
Print Name
No Filing Fee Required
Submit this form to:
Nebraska Department of Natural Resources
301 Centennial Mall South
PO Box 94676
Lincoln, Nebraska 68509
(402) 471-2363