REPORT OF WATER RIGHT CONVEYANCE
USE THIS CONVEYANCE REPORT FORM WHEN ONLY A PORTION OF THE WATER RIGHT IS CONVEYED.

Fill out this form, and then click the button to generate the printable form, then print the ROC PORTION form from the resulting .pdf file.
If you would like to print a blank ROC PORTION form, simply leave the water right number field blank, and click the button to generate the printable ROC form.
If you leave the water right number field blank, a blank ROC form will be produced.

The Adobe reader is required to print the ROC form. It can be acquired at the following link.

 
 
Water Right Number :  
 
Pending Change Applications : N/A
Under Non-Use : N/A
SECTION A. - WATER RIGHT INTEREST CONVEYED
1. New Owner(s) :
2. Mailing Address :
The above party(s) own the following portions of the water right as described above:
3. Beneficial Uses : Sole Supply Limit
      Irrigation : (ac)
      Stockwatering : (ELUs)
      Domestic : (families)
      Municipal : (ac ft)
      Industrial : (ac ft)
      Other : (Describe) (ac ft)
4. Diversion Limit (acre-feet) :
5. Special Conditions of Conveyance :
The above party(s) own the following hereafter portions of the change applications listed above:
6. Beneficial Uses : TotalSole Supply Limit
      Irrigation : (ac) (ac)
      Stockwatering : (ELUs) (ELUs)
      Domestic : (families) (families)
      Municipal : (ac ft) (ac ft)
      Industrial : (ac ft) (ac ft)
      Other : (ac ft) (ac ft)
7. Diversion Limit (acre-feet) :
8. Special Conditions of Conveyance
    related to Change Applications :
This report is only to update ownership interest records.
If a change is desired in any other aspect of the water right, a change application must be filed.
SECTION B. - CERTIFICATION
I, , certify that I retained to prepare and submit this Report of Water Right Conveyance on my behalf as the owner described in Section A. If this report was prepared as authorized by Administrative Rule R655-3-3, I further certify that the information contained herein or attached hereto is true and accurate to the best of my knowledge.
Date :          Phone Number :

I, , certify that I am licensed as
in the State of Utah, that my license number is , that I have received the attached documents and have prepared this Report of Water Right Conveyance or that it was done under my direct supervision, and that the information contained herein or attached hereto is true and accurate to the best of my knowledge. I further certify that the documents attached hereto evidence the ownership interest of the "New Owner(s)", named in Section A, in the water right interest listed in Section A :
Date :          Phone Number :
Address :
SECTION D. - CONVEYANCE SUMMARY 1
1. Deed Type :
Other Description
2. Date Signed :    Date Recorded :   
Book Number : Page Number :
Recorder's Number :
3. Grantor :
4. Portion of Beneficial Uses Conveyed : From Water RightFrom Pending Change Applications
 Sole Supply LimitSole Supply Limit
Irrigation : (ac) (ac)
Stockwatering : (ELUs) (ELUs)
Domestic : (families) (families)
Municipal : (ac ft) (ac ft)
Industrial : (ac ft) (ac ft)
Other : (ac ft) (ac ft)
5. Diversion Limit (acre-feet) :
6. Grantee :
7. Mailing Address :
8. Special Conditions of Conveyance :
INSTRUCTIONS
There are three steps to this Report of Conveyance (ROC) form.

  1. Fill out this online form with all pertinent information.
  2. Click the "Generate Official ROC Form" button (found at the top right corner of the form).
  3. Print the resulting .pdf form.

The form on this page is for data input only, and is not intended to be accepted as the official form.

The Division of Water Rights will NOT accept a screen print of this data input form as an official ROC form.

You must fill out this form AND THEN CLICK THE "GENERATE THE OFFICIAL FORM" button to produce this form.

 
 

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