This form MUST be completed and returned by November 15, 2025.
THIS FORM MUST BE SUBMITTED EVEN IF YOU ARE A CURRENT WELL HOLDER

If you are filling out this form for the first time, please click the New Submission button on the left.

If you are returning to edit or complete a previous submission, please fill out the email address and access code you set up previously and click Edit Submission.


First time submission




Edit existing submission
(fill out email address and access code to edit form)