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  
  The Perry and Nancy Boatwright Family Trust PO Box 270230, Fruitland UT 84027 1.0 AF: 0.25 acre
  Camelot International Resort Corporation PO Box 962, Duchesene UT 84021 13.51 AF; 3.3775 acres
  Orrin Farnsworth and Judy Farnsworth 12223 South Vista Drive, Riverton UT 84065 0.50 AF, 0.125 acre; joint tenants
  Alisa Graham 2284 West 12250 South, Riverton, UT 84065 0.50 AF, 0.125 acre, As Joint Tenants w/ Paula A Powell
  Paula A. Powell 2284 West 12250 South, Riverton, UT 84065 0.50 AF, 0.125 acre, As Joint Tenants w/ Alisa Graham
  Rigzen LLC 1425 South 200 East, Salt Lake City, UT 84115 25.0 AF; 6.25 acres
 
2. QUANTITY OF WATER & USES   (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: 0.345 cfs OR 40.51 acft CFS: AND/OR: ACFT:
 
   Group #  Supplemental Numbers/
Use Type		 Other Info Sole Supply Annual Quantity (Ac-ft)
    (726474) 43-11042
IRRIGATION:     10.1275 acre(s) acres
    (726477) 43-1276,9898,11042,11658,12049,12796
IRRIGATION:     0.0 acres
     
  Total:
 
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.)