* 1. Stream Name (Please write the full name of the stream or river)

* 3. City or Town (Please write city or town closest to the area of use)

* 4. Where is the stream being used? If use occurs in multiple locations, please list them all below. (Please be specific so the location can be identified on a map, e.g., 9th Street Bridge, Anytown City Park, Quarter Section-Township-Range, Latitude/Longitude, etc).

* 5. Have you or your family personally used the stream at this site(s) for recreation since Nov. 28, 1975?