"Affidavit for the Voluntary Cancellation of an Entire Water Right Certificate" - Oregon

Affidavit for the Voluntary Cancellation of an Entire Water Right Certificate is a legal document that was released by the Oregon Water Resources Department - a government authority operating within Oregon.

Form Details:

  • Released on July 1, 2021;
  • The latest edition currently provided by the Oregon Water Resources Department;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Oregon Water Resources Department.

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AFFIDAVIT FOR THE VOLUNTARY CANCELLATION OF AN ENTIRE
WATER RIGHT CERTIFICATE
State of Oregon
)
) ss
County of
)
I/We (or authorized agent),
,
residing at
,
telephone number
, being first duly sworn depose and say:
1. I/We are the legal and deeded owner(s) of the property described as tax lot number
,
within the
¼
¼, Section
, Township
N/S, Range
E/W, of the
Willamette Meridian, in
County, Oregon, as shown on
the attached map and described in the attached deed and legal description and made part of this
affidavit;
2. Water right certificate number
issued to
,
with a date of priority of
for use of
cubic foot per second of water
from
(source) for the
purpose of
(use) is
appurtenant to my/our property;
3. The appurtenant water right is/is not located within the boundaries of an irrigation, drainage, water
improvement, or water control district, or federal reclamation project (if the right is located within a
district or reclamation project, name it here:
);
4. The portion of the water right being cancelled is served by an irrigation district. The signature of the
district manager on the line below indicates the concurrence of the district to the cancellation of the
portion of the water right served by the district.
_
_
Signature of district manager
Printed Name
Date
If the water right is issued in the name of an irrigation district then the affiant must have the
5.
concurrence of the district to the cancellation of the portion of the water right. (Signature
of district manager on the line below documents consent of the district.)
_
_
Signature of district manager
Printed Name
Date
7/1/2021
Page 1 of 2
AFFIDAVIT FOR THE VOLUNTARY CANCELLATION OF AN ENTIRE
WATER RIGHT CERTIFICATE
State of Oregon
)
) ss
County of
)
I/We (or authorized agent),
,
residing at
,
telephone number
, being first duly sworn depose and say:
1. I/We are the legal and deeded owner(s) of the property described as tax lot number
,
within the
¼
¼, Section
, Township
N/S, Range
E/W, of the
Willamette Meridian, in
County, Oregon, as shown on
the attached map and described in the attached deed and legal description and made part of this
affidavit;
2. Water right certificate number
issued to
,
with a date of priority of
for use of
cubic foot per second of water
from
(source) for the
purpose of
(use) is
appurtenant to my/our property;
3. The appurtenant water right is/is not located within the boundaries of an irrigation, drainage, water
improvement, or water control district, or federal reclamation project (if the right is located within a
district or reclamation project, name it here:
);
4. The portion of the water right being cancelled is served by an irrigation district. The signature of the
district manager on the line below indicates the concurrence of the district to the cancellation of the
portion of the water right served by the district.
_
_
Signature of district manager
Printed Name
Date
If the water right is issued in the name of an irrigation district then the affiant must have the
5.
concurrence of the district to the cancellation of the portion of the water right. (Signature
of district manager on the line below documents consent of the district.)
_
_
Signature of district manager
Printed Name
Date
7/1/2021
Page 1 of 2
6. I/We have abandoned any and all interest in this water right and request the right be canceled.
Signature of legal owner as listed on deed, or authorized agent
Date
Signature of legal co-owner as listed on deed
Date
(If applicable)
Subscribed and Sworn to Before Me this
day of
, 200
.
Notary Public for Oregon
My Commission Expires
PLEASE ATTACH A LEGIBLE COPY OF:
1) A DEED WHICH LISTS LAND OWNERS AND INCLUDES A LEGAL DESCRIPTION OF AFFECTED LANDS, AND
2) A COPY OF AN ADJUDICATION MAP, WATER RIGHT FINAL PROOF MAP, OR A TAX LOT MAP WITH THE ABANDONED
RIGHT CLEARLY DRAWN AND IDENTIFIED.
3) IF ACTING AS AN AUTHORIZED AGENT, INCLUDE COPY OF POWER OF ATTORNEY OR OTHER DOCUMENTS GRANTING
AUTHORITY TO ACT ON BEHALF OF LEGAL OWNER(S).
7/1/2021
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