Flow Rate Affidavit

This affidavit is to be executed by an affiant who is an owner of a water right number and stating the flow rate prior to July 1, 1973.




STATE OF MONTANA                     )

) ss.                                         CASE NO.

COUNTY OF __________________)






  1. I/We ________________________________________________ are the owner(s) of water right number ___________________________.


  1. The flow rate prior to July 1, 1973 is _____________.


  1. I/We hereby swear that the information contained in this Affidavit is true.




___________________________________________                           __________________

(Owner)                                                                                                         (Date)


___________________________________________                                  __________________

(Owner)                                                                                                          (Date)



State of Montana

County of __________


Subscribed to and sworn to (or affirmed) before me this ____day of __________________2004,


by (print signer=s name) _______________________________________________________.




(SEAL)                                                      Print Name: ______________________

Notary Public for the State of Montana

Residing in _______________________ County

My Commission Expires ____________