805 Dorsey Street
P.O. Box 826
Beatrice, Nebraska 68310
402-228-3402
FAX: 402-223-4441

LBBNRD Home
 Cost-Share Programs
 Well Decommissioning Info
Contact the NRD

Well Decommissioning Cost-share Program

Well Decommissioning Form - front page   go to back page

Landowner/Recipient Name Phone  (       )         -
  Address City  State Zip
Landowner/Recipient of payment Social Security Number             -          -    OR Farm Tax ID Number             -  
Legal Description of Well              1/4

1/4 of Section

          T          R             County
Diameter of Well Casing Depth of Well
Date Well Commissioned If Registered, Well Registration Number
Type of Well    (Circle One) Domestic Stock Irrigation Other
Well Contractor or Pump Installer's Name
  Address City State Zip
  Phone License Number of Well Contractor or Pump Installer
Actual Cost  $ Amount cost-shared  $
Other special notes or comments:

 
   
Landowner's Signature                                   Date

NRD Representative                               Date