Self-Cert Form

Determine Your Eligibility to Use a Previously Issued Certificate

Self-Certification of Exemption Form

Not Eligible

You do not qualify to use a previously issued certificate. Please apply for a new certificate.

If you have any questions, please contact the Assured and Adequate Water Supply Program at (602) 771-8599

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
Please answer the question!


Do you represent a qualified platting authority?

PDF list of qualified platting authoritiesPDF list of qualified platting authorities


Is the certificate number currently valid?

Please search the certificate number in our imaged records database to confirm


Did the ADWR Director issue a 'Type A' certificate to the previous land owner?

See examples of "Type A" certificates


Water service is currently available to each lot with-in the subdivided land and the water provider listed on the Certificate has not changed?


Has the certificate been revoked, or is it currently involved in revocation proceedings?

Please refer to our notices of certificate revocation


Does the subdivided land qualify as a member land of CAGRD?

Please visit the CAGRD website to use the member land search.


Has the plat submitted in the application changed?

This information can be found by comparing the previous application with your new application.


After reviewing the criteria certify that is eligible to use certificate #.

Eligible

You qualify to use a previously issued certificate. Please email this determination to the Assured and Adequate Water Supply Program for our Records.

If you have any questions, please contact the Assured and Adequate Water Supply Program at (602) 771-8599