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AFFTOAVIT OF IRRIGATION WA'T'ER AVAILABILITY <br />STATE OF WASHINGTON ) <br />} ss. <br />COUNTY OF KITTITAS } <br />1, . the undersigned, do hereby affirm and attest to the following: <br />1) 1 am the owner of certain real property located in Kittitas County, Washington, with a physical address <br />and/or parcel number of. <br />Parcel Number: <br />Address: <br />2) 1 declare that: <br />13 The above described property has access to an irrigation water supply for outdoor use (please <br />check one of the boxes below). (Package "A") <br />0 Adequate water right for irrigation purposes <br />© Accessible water shares from an irrigation district <br />13 Previously established beneficial use under permit exemption for irrigation purposes up <br />to one half acre <br />The above described property does W have access to an irrigation water supply for outdoor use <br />(please check one of the boxes below). (Package `B") <br />13 No water rights for irrigation purposes available <br />© No access to water rights for irrigation purposes <br />3) 1 further declare under penalty of perjury under the laws of the State of Washington that the foregoing is <br />true and correct. <br />EXECUTER this day of 24 _ atWashington. <br />Affiant Signature <br />SUBSCRIBED and SWORN to (or affirmed) before me this day of , 20 <br />(Notary Seal) <br />NOTARY PUBLIC in and for the State of Washington, <br />residing at <br />My commission expires: <br />Kittitas County Water Mitigation Application Page 4 of 5 <br />