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Mail form PO Box 94676 Lincoln, NE 685094676 STATE OF NEBRASKA Phone 40)47263 DEPARTMENT OF NATURAL RESOURCES Phone (40)4714363WATER WELL RECISTRITIONIRegistration Date e?/a76 2Sequence No. Owner
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Get a copy of the 2010 submit to department form.
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Attach any supporting documents if required, such as identification proof or relevant certificates.
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Sign and date the form in the designated area.
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Submit the filled-out form to the department either in person or through the designated method mentioned in the instructions.
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