Forms • Churchill County, NV • CivicEngage

As an attribute of real property, water rights must be considered when valuing real property. Please help us confirm the information from the sale of water rights described below:

Document Number:*

Date of Sale:

Water Righted Acres Purchased:

TCID Serial Number:

Water Rights Sold from Parcel Number:

COMPLETE STEPS 1-6 BELOW:

1. Is the above water right information correct?

Yes

No

If NO, complete the changes below:

Deeded Water Rights:

TCID Water Righted Acres:

TCID Serial Number:

State Permit Number:

Farm Unit?

Yes

No

If YES, Number:

2. Please indicate the parcel or address where the water rights sold will be used, if known:

TCID Serial Number or State Permit Number:

3. Is the above information correct?

Yes

No

If NO, complete the changes below:

Owner Name:

Legal/Corporation Name:

Mailing Address:

4. Do any of the following apply?

A. Additional Water Rights Purchased:

Yes

No

Date Purchased:

Purchased From:

TCID Serial Number or State Permit Number:

B. Water Rights Sold

Yes

No

Date Sold:

New Owner:

TCID Serial Number or State Permit Number:

C. Water Rights Leased

Yes

No

Date Leased:

Leased to:

TCID Serial Number or State Permit Number:

5. Please provide any additional information that may be relevant to the water right information on the above listed parcel. (i.e.: no delivery, disputes, etc.):

OATH: Under penalty of perjury, I do hereby solemnly and truthfully declare and affirm that I have examined this water right declaration and any changes made therein and to the best of my knowledge and belief it is truly correct and complete.

Signature:

Print Name:

Date:

Phone Number:

* indicates required fields.

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