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SEGREGATION REQUEST FORM
   
The Adobe reader is required to print this form. It may be acquired at the following link.
INSTRUCTIONS:
   
  1. Enter Water Right Number, and then click 'Display Data'

  2. Enter the applicable segregation information:

    1. OWNERSHIP - Select all the owners that are requesting the segragation.
      (Ownership of the water right to be segregated MUST be clearly defined. If the right is to be segregated by less than all of the owners, then undivided interests must be split to establish definite, unique interests among all parties. If a right has multiple owners and if the interests are not cleary defined then all of the owners on the right must sign the segregation request.)

    2. QUANTITY OF WATER & USES - Specify the quantity of water and the uses that are being segreagted.
      (The sole supply quantifications for each use in each water use group that are being affected by this segregation MUST be established prior to a segregation request being filed. The ownership interests when totaled MUST equal the sole supply quantifications.)

    3. QUANTITY OF WATER & USES FROM CHANGE - If the water rights has an approved change application then the quantity of water and the uses that are being segregated from the change must also be specified.

    4. EXPLANATORY - An Explanatory Section is also avalable to provide space for additional detail that may be necessary to properly segregate the water right.


  3. When finished, generate the printable form by clicking 'Print Data'.

  4. All owners involved in the Segregation MUST then sign the form in the spaces provided.

  5. Finally, Print and Mail the Form or bring it to the Division of Water Rights ALONG WITH THE FEE of $50.00.
 
  Water Right Number To Be Segregated:   
 
 
 
1. OWNERSHIP:   (Please check the owner(s) to be Segregated.)
 
     Name    Address    Interest  
  Hollis Earl and Elaine Ruth Gowin P. O. Box 83, Fillmore UT 84631 100% joint tenants
 
2. QUANTITY OF WATER & USESx   (Please indicate the amount of water and uses being SEGREGATED in the boxes provided.   
 
     Water/Use  Currently in Parent Right  Amount to be Segregated  
    FLOW / QUANTITY: 0.015 cfs
acftPresent: 0
cfsPresent: 1 CFS:
groupWrnumsCount: select count(*) as totalRows from GROUP_WRNUMS where WRNUM = '67-96' and ADJUD_ACTION_FLAG <> 'A'
   
    DOMESTIC: 1 EDUs
    MISCELLANEOUS: Incidental irrigation and stockwatering. [10.41 acft]  ACFT
  
3. EXPLANATORY:     (Please use this space, or attach additional pages, to provide additional detail that may be necessary to properly segregate the water right. If needed, provide a legal description of the place of use of the water right and property affected by this segregation.)   
 
   
   
 

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