ImmbltSInes Ciamitsir NEW MEXICO OFFICE OF THE STATE ENGINEER

File No. ImmbltSInes Ciamitsir NEW MEXICO OFFICE OF THE STATE ENGINEER APPLICATION FOR PERMIT TO CHANGE AN EXISTING WATER RIGHT (Non 72-12-1) (check applicable boxes): For fees see State Engineer website: heorwww.ose.state.nm.usi D Change Purpose of Use 0 Groundwater 0 Surface Water 0 Change Place of Use 0 Additional Groundwater Point of Diversion (POD) 0 Additional Surface Water Point of Diversion (POD) Change Point of Diversion (POD): From: Groundwater 0 Surface Water To: 0 Groundwater • Surface Water 0 Groundwater 0 Surface Water M Temporary Change. NMSA 1978, § 72.12-7(B) Requested Start Date: Requested End Date: (Not to Exceed 3 ac-ft in One Year) 0 Water Use Lease, NMSA 1978, §§ 72-6-1 to-7 Requested Start Date: Requested End Date: 1. APPLICANT(S) (Required) Note: water-right owner must be listed as an applicant. Name: Cypress, Inc. Name: Contact or Agent: check here if Agent 0 Brice M. Gordon Contact or Agent: check here if Agent • Mailing Address: 49 Zorro Ranch Road Mailing Address: City: Stanley City: State: NM Zip Code: 87056 State: Zip Code: Phone: 0 Home 0 Cell Phone (Work): Phone: Phone (Work): El Home • Cell E-mail (optional): E-mail (optional): 2. CURRENT OSE FILE INFORMATION (Required) OSE File No(s): E-7871 ET ALS. Priority Date (if known): 11/22/2000 Subfile/Cause No. (if applicable): 3. CURRENT PURPOSE OF USE AND AMOUNT OF WATER (Required) Domestic 0 Livestock 0 Irrigation 0 Municipal ❑ Industrial 0 Commercial 0 Other Use (specify): Ranch Related Describe a specific use If applicable (i.e. sand & gravel washing, dairy etc): Amount of Water (acre-feet per annum): If more details are needed, type "See Comments" in "Other" field below, and explain in Additional Statements Section. Diversion: 68 a/f Consumptive Use: 68 a/f Other (include units): FOR 0SE INTERNAL USE Application for Permit, Form wr-06, Rev 9/26/12 File No.: Tm. No.: Receipt No.: Trans Description (optional): Sub-Basin: PCW/LOG Due Date: PEW Due Date: Page 1 of 6 EFTA01083169 4. COUNTY WHERE WATER RIGHT IS CURRENTLY USED (Required) Santa Fe 5. ADDITIONAL STATEMENTS CONCERNING THE CURRENT WATER RIGHT 6. CURRENT or MOVE-FROM POINT(S) OF DIVERSION (POD) (Required) 0 Surface POD OR g Ground Water POD (Well) Name of ditch, acequia, or spring: Stream or water course: Tributary of: If application proposes a new point of diversion involving a diversion dam, storage dam, main canal, and/or pipeline, complete Attachment 2. 0 Check here if Attachment 2 is included in this application packet. POD Location Required: Coordinate Latitude/Longitude (LaVLong District II (Roswell) & District 0 NM State Plane (NAD83) 0 NM West Zone 0 NM East Zone 0 NM Central Zone location must be reported in NM - WGS84). VII (Cimarron) customers, provide a (Feet) 0 UTM (NAD83) (Meters) State Plane (NAD 83), UTM (NAD 83), or PLSS location in addition to above. 0 Lat/Long (WGS84) (to the nearest 1/10th of second) NI Zone 12N Ozone 13N POD Number (if known): X or Easting or Longitude: Y or Northing or Latitude: Provide if known: -Public Land Survey System (PLSS) (Quarters or Halves, Section, Township, Range) OR - Hydrographic Survey Map 8 Tract; OR - Lot, Block 8 Subdivision; OR - Land Grant Name E-7871S 105° 57' 43.6" 35° 14' 5.6" NE 114 NE 114 SE 1/4 Sec. 27 T12N RO9E NOTE: If more PODS need to be described, complete form WR-08 Additional point of diversion descriptions are attached: 0 Yes Attachment 1 — POD Descriptions) s No If yes, how many Point of Diversion is on Land Owned by: Cypress, Inc. Other description relating point of diversion to common landmarks, streets, or other: FOR 0SE INTERNAL USE Application for Permit, Form wr-06 File Number: Tm Number. Page 2 of 6 EFTA01083170 7. CURRENT or MOVE-FROM PLACE(S) OF USE (Required) The land is legally described by (check all that apply): lz Public Land Survey System (PLSS) (quarters. section, township, range) 0 Irrigation or Conservation District Map Complete the blocks below for all tracts of land (more than one Survey Report or Map be provided for a tract if available): E Hydrographic E Subdivision 0 Grant description can PLSS Quarters or Halves, and/or PLSS Section and/or PLSS Township and/or PLSS Range Acres Priority Name of Hydrographic Survey, and/or Map No. and/or Tract No. (Please list each tract individually) and/or Name of Irrigation or Conservation District, and/or Lot No. Name and County of Subdivision and/or Block No. Grant SW1/4 SW1/4 NE1/4 and NE1/4 SE1/4 NW1/4 15 12N 09E 4 11/22/2000 SE 114 22 12N 09E 20 11/22/2000 Total Acres: Other description relating place of use to common landmarks, streets, or other: 24 Place of use is on land owned by (required): Cypress, Inc. Are there other sources of water for these lands? No 0 Yes ED describe by OSE file number: E-6478 Note: If on Federal or State Land, please provide copy of lease. FOR OSE INTERNAL USE Application for Permit, Form wr-06 File Number: Tm Number. Page 3 of 6 EFTA01083171 8. MOVE-TO PURPOSE OF USE AND AMOUNT OF WATER (Complete this section ONLY if the purpose of use is changing) 0 Domestic Livestock Irrigation 0 Municipal 0 Industrial 0 Commercial Other Use (specify): Ranch Related 1.9 Describe a specific use If applicable (i.e. sand & gravel washing. dairy etc): Amount of Water (acre-feet per annum): If more details are needed, type "See Comments' in 'Other field below, and explain in Additional Statements Section. Diversion: 68 aft Consumptive Use: 68 a/f Other (include units): 9. MOVE-TO POINT(S) OF DIVERSION (POD) (Complete this section ONLY if adding or replacing a POD) 0 Surface POD OR IME Ground Water POD (Well) Name of ditch, acequia, or spring: Stream or water course: Tributary of: If application proposes a new point of diversion involving a diversion dam, storage dam, main canal, and/or pipeline, complete Attachment 2. 0 Check here if Attachment 2 is included in this application packet. POD Latitude/Longitude District 0 NM 0 III 0 Location Required: Coordinate location must be reported in NM State Plane (NAD (Lat/Long - WGS84). II (Roswell) & District VII (Cimarron) customers, provide a PLSS location in addition State Plane (NAD83) (Feet) 0 UTM (NAD83) (Meters) NM West Zone Ozone 12N NM East Zone Ozone 13N NM Central Zone 83), Sit 1/10th UTM (NAD 83), or to above. Lat/Long (WGS84) (to the nearest of second) POD Number (if known): X or Easting or Longitude: Y or Northing or Latitude: Provide if known: -Public Land Survey System (PLSS) (Quarters or Halves , Section, Township, Range) OR - Hydrographic Survey Map & Tract; OR - Lot, Block & Subdivision; OR - Land Grant Name E-6478-S2 105° 57' 44.2" 35° 14' 0.2" SE 1/4 NE 1/4 SE 1/4 Sec. 27 T12N R09E NOTE: If more PODS need to be described, complete form WR-08 Additional POD descriptions are attached: 0 Yes 0 No Attachment 1 - POD Descriptions) If yes, how many Other description relating point(s) of diversion to common landmarks, streets, or other: Point of Diversion is on Land Owned by: Cypress, Inc. Note: The following information is for wells only. If more than one Approximate depth of well (feet): 600.00 (1) well needs to be described, provide attachment. Outside diameter of well casing (inches): 5.00 Driller Name: Hydrogeologic Services Driller License Number: WD-1472 If replacing the current well. is the current well to be plugged? 0 Yes 0 No If No. state for what use it is retained: Et Not Applicable FOR OSE INTERNAL USE Application for Permit, Form wr-06 File Number: Tm Number. Page 4 of 6 EFTA01083172 10. MOVE-TO PLACE(S) OF USE (Complete this section ONLY if adding or changing a place of use) List each individually The land is legally described by (check all that apply): O Hydrographic Survey Report or Map 0 Public Land Survey System (PLSS) (quarters, section, O Subdivision township, range) O Grant O Irrigation or Conservation District Map Complete the blocks below for all tracts of land (more than one description can be provided for a tract if available): PLSS Quarters or Halves, and/or PLSS Section and/or PLSS Township and/or PLSS Range Acres Priority Name of Hydrographic Survey, and/or Map No. and/or Tract No. (Please list each tract individually) and/or Name of Irrigation or Conservation District, and/or Lot No. Name and County of Subdivision and/or Block No. Grant See attached Ex. A for Places of Use 11/22/2000 Total Acres: Other description relating place of use to common landmarks, streets. or other: Place of use is on land owned by (required): Cypress, Inc. Are there other sources of water for these lands? describe by OSE file number: E-6478 No O Yes Cr Note: If on Federal or State Land, please provide copy of lease. FOR OSE INTERNAL USE Application for Permit, Form wr-06 File Number: Tm Number. Page 5 of 6 EFTA01083173 11. ADDITIONAL STATEMENTS OR EXPLANATIONS See attached Ex. B for additional statements. ACKNOWLEDGEMENT I, We (name of applicant(s)). Darren K. Indyke, Esq. Print Name(s) affirm that the foregoing statements are true to the best of (my, our) knowledge and belief. Applicant Signature Applicant Signature ACTION OF THE STATE ENGINEER This application is: approved 0 partially approved 0 denied provided it is not exercised to the detriment of any others having existing rights, and is not contrary to the conservation of water in New Mexico nor detrimental to the public welfare and further subject to the attached conditions of approval. Witness my hand and seal this day of 20 , for the State Engineer, State Engineer By: Signature Title: Print Print FOR 0SE INTERNAL USE Application for Permit, Form wr-06 File Number: Tm Number. Page 6 of 6 EFTA01083174