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AFFIDAVIT OF ANNUAL ASSESSMENT LABOR
LODE MINING CLAIM
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STATE OF WYOMING
: 55.
COUNTY OF LINCOLN
.
.
The undersigned, being duly sworn, states:
1. At least $ 100.00 worth of labor or improvements was
performed or made during the annual assessment year beginning
at noon on September 1,2004 and ending at noon on September 1,
2005 upon or for the benefit of the following listed lode mining
claim:
Name of claim
Recordéd in
book/page(s)
BLM
Serial No(s).
Peacock Claim #1
562/557
14/194
WMC260692
2. The labor or improvements consisted of Mining, which
consisted of removing the valuable minerals, either from the ledge
itself or fallen to the base, or that had fallen or washed down
the existing stream bed.
and was done at the following location: Peacock Claim #1
3. The person(s) who performed the labor or improvements
are identified as follows: Heather Hulse, Mike Hulse, Jesse Allred,
C. Mark Allred, Darlene A. Allred, and Doreen Allred.
4. Said labor or improvements were made at the request and
for the benefit of C. Mark Allred owner of Peacock Claim #1.
Dated:
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Subscribed in my presence and
day of Q~~ l l ~ v;}.OC)~
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sworn to before me this
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§ignature of Affiants
A.D.2005
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Notary Public
My commission expires
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CATHEHlNE M. WALTERS· NOTARY PUBUC
County of ~~~ State of
lincoln ~ Wy,omip!J
My Cornrnlsslon E)(I:ili"GS ¿/J,' ~I. .,,1325:.'8-
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RECEIVED 12/20/2005 at 11:18 AM
RECEIVING # 914579
BOOK: 607 PAGE: 832
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY