ESCROW RECEIPT
RESPECTING
BESSEMER IRRIGATING DITCH COMPANY STOCK

St. Charles Mesa Water District (the District) hereby acknowledges receipt of the following documents and things from___________________________________(collectively, the Applicant) this__________day of___________________, 20_________:

(r)   The sum of $500.00 in the form of_______________________________.

(s)   Bessemer Irrigating Ditch Company (the Company) stock certificate number___________________________representing___________________share of stock in the Company, standing in the name of Applicant;

(t)   Special Warranty Deed conveying the above described stock to the District, dated_________________________________; and,

(u)   Stock Assignment separate from Certificate authorizing the Secretary of the Bessemer Irrigating Ditch Company to transfer the above described shares of stock to the District on the books and records of the Bessemer Irrigating Ditch Company.

The funds and documents are being delivered to the District by the Applicant in conjunction with Applicant’s application for water service by the District, as set out in detail in the Agreement Respecting the Provision of Water and Providing of Bessemer Irrigating Ditch Company Stock, between District and Applicant dated .

District shall hold in escrow and subsequently deal with the above described funds, stock certificate and special warranty deed as provided under the terms of the Agreement Respecting the Provision of Water and Providing of Bessemer Irrigating Ditch Company Stock.

St. Charles Mesa Water District

By__________________________________
   David K. Simpson District Manager