Amendment Statement of Claim of Right to Use Public Waters of the State of Arizona - Arizona

This "Amendment Statement of Claim of Right to Use Public Waters of the State of Arizona" is a document issued by the Arizona Department of Water Resources specifically for Arizona residents with its latest version released on June 1, 2016.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Arizona Department of Water Resources.

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ARIZONA DEPARTMENT OF WATER RESOURCES
SURFACE WATER PERMIT UNIT
MAIL TO: 1110 W. Washington Street Ste 310
_____________
REGISTRY NO. OF ORIGINAL FILING
Phoenix, Arizona 85007
_____________
Telephone (602) 771-8621
DATE _
Fax (602) 771-8689
AMENDMENT
STATEMENT OF CLAIM OF RIGHT TO USE PUBLIC WATERS OF THE STATE OF ARIZONA
1.
Claimant
Telephone_______________________
Address
City
State
Zip____________ __
2.
Type of water source and name _____________________________________________________________________
a tributary to
within the
watershed
(for office use only)
3.
Type of Water Use(s)
Annual Use
Acres Irrigated
Specific Months of Use
(e.g., irrigation, domestic, stock)
(list use amount for each type)
(irrigation use only)
(if not for entire year)
4.
Date the water was first used beneficially (month/day/year) ____________
Location of point of water diversion: County ___________________
5.
Parcel I.D. No.
and/or Lot No.
and
¼
¼, Section
, Township
N/S, Range
E/W
6.
Location of place(s) of water use: County _____________________
Parcel I.D. No.
and/or Lot No.
and
¼
¼, Section
, Township
N/S, Range
E/W
Parcel I.D. No.
and/or Lot No.
and
¼
¼, Section
, Township
N/S, Range
E/W
7.
Legal basis for the claim (attach any documents being filed in support of claim):
________________________________________________________________________________________________
_______________________________________________________________________________
The information contained herein is true and correct to the best of my (our) knowledge.
STATE OF ARIZONA
)
)
County of
)
_____________________________________________
__________________________________________
Signature(s)
SUBSCRIBED AND SWORN to before me this
day of
, 20
.
My commission expires
______________________________________________
Notary Public
Revised 6/2016
ARIZONA DEPARTMENT OF WATER RESOURCES
SURFACE WATER PERMIT UNIT
MAIL TO: 1110 W. Washington Street Ste 310
_____________
REGISTRY NO. OF ORIGINAL FILING
Phoenix, Arizona 85007
_____________
Telephone (602) 771-8621
DATE _
Fax (602) 771-8689
AMENDMENT
STATEMENT OF CLAIM OF RIGHT TO USE PUBLIC WATERS OF THE STATE OF ARIZONA
1.
Claimant
Telephone_______________________
Address
City
State
Zip____________ __
2.
Type of water source and name _____________________________________________________________________
a tributary to
within the
watershed
(for office use only)
3.
Type of Water Use(s)
Annual Use
Acres Irrigated
Specific Months of Use
(e.g., irrigation, domestic, stock)
(list use amount for each type)
(irrigation use only)
(if not for entire year)
4.
Date the water was first used beneficially (month/day/year) ____________
Location of point of water diversion: County ___________________
5.
Parcel I.D. No.
and/or Lot No.
and
¼
¼, Section
, Township
N/S, Range
E/W
6.
Location of place(s) of water use: County _____________________
Parcel I.D. No.
and/or Lot No.
and
¼
¼, Section
, Township
N/S, Range
E/W
Parcel I.D. No.
and/or Lot No.
and
¼
¼, Section
, Township
N/S, Range
E/W
7.
Legal basis for the claim (attach any documents being filed in support of claim):
________________________________________________________________________________________________
_______________________________________________________________________________
The information contained herein is true and correct to the best of my (our) knowledge.
STATE OF ARIZONA
)
)
County of
)
_____________________________________________
__________________________________________
Signature(s)
SUBSCRIBED AND SWORN to before me this
day of
, 20
.
My commission expires
______________________________________________
Notary Public
Revised 6/2016
INSTRUCTIONS
AMENDING A STATEMENT OF CLAIM OF RIGHT TO USE PUBLIC WATERS
OF THE STATE OF ARIZONA
Statements of claim of right received by the Arizona Department of Water Resources are presumed
to be a correct statement of the facts contained therein. This amendment procedure is provided to
allow a water user the opportunity to correct facts which were incorrectly presented in the original
document. This amendment procedure is not intended to act as a vehicle for reporting changes in
location, quantity, source, or use of water that have occurred since the date of first beneficial use
stated on the original claim. For changes of this type, completion of a new statement of claim of
right or request for change in use may be more appropriate. A change in holder of the statement of
claim of right would be accomplished through a request for assignment.
1. Complete only those portions of the statement of claim of right that are being amended from the
original statement of claim of right. For example, if you are amending the date the water was
first used, complete only item number 4.
2. Record the registry number of the statement of claim of right that is being amended. This
registry number is prefixed with 36.
3. The amendment to a statement of claim of right must be subscribed and sworn to.
4. There is no fee to amend a statement of claim of right.
Revised 6/2016
WORKSHEET TO ASSIST IN DETERMINING QUANTITIES OF USE
Beneficial Uses Include, but are not Limited to, Domestic, Municipal, Recreation, Wildlife, Including Fish,
Agricultural, Mining, Stockwatering, and Power Purposes
Statement of Claim of Right No. ______________________________
(for office use only)
This worksheet and the Standard Water Use Quantities guide are provided as a means to help you calculate
water use. Complete only those sections that apply to your use(s). Enter each total from this worksheet in
section #3 of the Statement of Claim.
DOMESTIC
# of people using water
X
Standard quantity
=
Amount & measure
GPA
Non-domestic household use
Trees, shrubs, irrigation for ½ ac
=
Amount & Measure
GPA
Total annual amount for domestic
STOCKWATERING
X
Standard quantity
X
Number of days
=
Amount & measure
# & type of head
per head per day
per year water is used
GPA
GPA
Total annual amount for stockwatering
GPA
WILDLIFE
X Standard quantity
X
Number of days
=
Amount & measure
# & type of head
per head per day
per year water is used
GPA
GPA
Total annual amount for wildlife
GPA
Revised 6/2016
STANDARD WATER USE QUANTITIES
DOMESTIC USE:
180 gallons/person/day
Domestic use can include irrigation of less than 0.5 acres of lawn and garden associated with a
domicile.
STOCKWATERING USE:
Cattle/Horses
12 gallons/animal/day
Hogs
2.5 gallons/animal/day
Sheep
1.5 gallons/animal/day
Poultry
0.25 gallons/animal/day
WILDLIFE USE:
Elk
3 gallons/animal/day
Antelope/Deer
1 gallon/animal/day
Other
0.5 gallon/animal/day
If you require assistance determining quantity of use for a water use not listed, please contact the
Permitting Unit at (602) 771-8621 or 1-800-352-8488 (within Arizona only).
Revised 6/2016

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