Water Transfer Authorization Form

Lost Hills Water District

3008 Sillect Avenue, Suite 205

Bakersfield CA 93308

Please make the following transfer(s) effective .

From: To:

Farm Name SA Acre Feet Receiving Farm Name SA

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

_________________________________ _____ ____________ ______________________________ _____

Authorized by ______________________________________

______________________________________

______________________________________

Dated/On ______________________________________