Form 637, New 02/02/2010
File In _________________________
REINSTATEMENT REQUEST
For a Provisional Permit or Change Authorization
Use this form to request reinstatement of a
terminated water right. This form can only be
used if the water right was terminated because:
FOR DEPARTMENT USE ONLY
1. A Project Completion Notice was not filed by
Rec'd By
_______________________________________
the deadline
Fee Rec'd $ ____________
Check No. _____________
-or-
Deposit Receipt # __________________________________
2. A Request for Extension of Time was not filed
Payor (if different from name(s) listed in item 1 below)
by the deadline
__________________________________________________
(§85-2-312(3), MCA)
Refund $ __________________ Date _________________
Filing Fee $200
1.
NAME _______________________________________________________________________________________________
MAILING ADDRESS
________________________________________________________________________________
CITY
__________________________________
STATE _________________
ZIP
________________
WORK PHONE ___________________
HOME PHONE_______________ CELL PHONE____________________
Who is the current owner of the terminated water right? Check one.
2.
Owner listed in the DNRC water right record.
Owner not listed in the DNRC water right record.
*If the owner is not listed in DNRC records, and the owner transfer occurred prior to July 1, 2008, an Ownership
Update (Form 608) and the associated filing fee must be submitted along with this form.
Request is to reinstate Provisional Permit/Change Authorization number:
3.
__________________________
Why is this request being made?
4.
Attach a Project Completion Notice (Form 617 for Provisional Permit or Form 618 for Change
5.
Authorization) to this form. The information provided must conclusively show that the project was
completed by the deadline stated on the permit/change authorization. Options include, but are not
limited to:
Invoices from purchases for project
Dated Map showing completed project
Power Bills for project operation
Dated Pictures
Rental Equipment receipts
Notarized affidavit
The statements appearing here are to the best of my knowledge true and correct.
6.
Signature:
___________________________________________________
Date: _______________
Signature:
___________________________________________________
Date: _______________