Form No. 627 Notice Of Water Right printable pdf download

Form No. 627 R8/03

NOTICE OF WATER RIGHT

(EXEMPT FROM THE ADJUDICATION FILING REQUIREMENTS)

IMPORTANT NOTE

Water rights for stock and domestic (one household) uses from groundwater

FOR DEPARTMENT USE ONLY

sources (wells, developed springs) were exempted from the filing requirements

for claims of existing water rights in the general adjudication of water rights if they

Application No. _________________ Basin _________

met either of the following criteria.

Date Received ________________________________

The water must have been in use prior to January 1, 1962, or

Rec'd By _____________________________________

The water must have been put to use between January 1, 1962 and

Fee Rec'd $ ___________________________________

July 1, 1973, and a notice filed under the 1961 Groundwater Codes.

Check No. ____________________________________

Transmittal No. ________________________________

Instream domestic or stock use in use prior to July 1, 1973, was also exempted

Refund $ _________________ Date ______________

from the filing requirements.

A person who claims to have a water right that is exempt may file this form for the purpose of receiving notice from the Department of

permit applications, change authorizations, or reservations that may affect the owner's water right. Filing this notice does not relieve

a person of the responsibility of establishing the existence of the water right. Acceptance of this form by the Department does not

constitute a recognition by the State of Montana that the right is a valid existing water right.

Submit the completed form to the Water Resources Office serving the county in which the development is located, as listed on the

back of this form.

Filing Fee:

$50.00

1. OWNER'S NAME(S) _____________________________________________________________________________

Mailing Address __________________________________________________________________________________

City _________________________________________ State _______________________ Zip __________________

Home Phone __________________________________ Other Phone _______________________________________

DATE THE WATER WAS FIRST USED Month ______________ Day _______________ Year ________________

If only a year is entered, DNRC will assign December 31 as the month and day. If month and year is entered, DNRC will

assign the last day of the month.

DATE OF FILING OF WATER USE FROM THE COUNTY COURTHOUSE RECORDS (attach copy)

_______________________ (month/day/year) __________________ Document No. ____________________ County

4. SOURCE OF WATER (well, spring, or name of lake, etc.) ________________________________________________

5. DIVERSION RATE (gallons per minute) ______________________________________________________________

6. POINT OF DIVERSION (POD) Describe the location where water is diverted from the source.

____ 1/4 _____ 1/4 ____ 1/4 Sec _____ , Twp _____ N/S, Rge _____ E/W, County __________________________

Lot ________ Blk _________ Tract No. ____________ COS # ______________ Subdivision (if any) _____________

7. PLACE OF USE:

Purpose of Use: ______________________________________ , if place of use is the same as POD, CHECK

____ 1/4 _____ 1/4 ____ 1/4 Sec _____ , Twp _____ N/S, Rge ____ E/W, County __________________________

Lot ________ Blk _________ Tract No. ____________ COS # ______________ Subdivision (if any) _____________

Purpose of Use: ______________________________________ , if place of use is the same as POD, CHECK

____ 1/4 _____ 1/4 ____ 1/4 Sec _____ , Twp ____ N/S, Rge ____ E/W, County __________________________

Lot ________ Blk _________ Tract No. ____________ COS # ______________ Subdivision (if any) _____________

MONTANA DEPARTMENT OF NATURAL RESOURCES AND CONSERVATION

1424 9TH AVE., P.O. BOX 201601, HELENA, MT 59620-1601 444-6610

WEBSITE:

Form No. 627 Notice Of Water Right

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