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BOOK-'4- PRPAüÜ 30:J-
-
AFFIDIA VIT AND NOTICE OF INTENT TO HOLD MINING CLAIMS
TO ALL WHOM IT MAY CONCERN:
The undersigned certifies that the owner or claimant intended or
intends to hold the mining claim(s) listed below from 12:00 p.m.
on September 1 of the year before this affidavit was made and recorded,
until 11 :59 a.m. on September 1 of the year that this affidavit
was made and recorded.
000435
The undersigned hereby affirms that this document submitted for
recording does not contain a social security number.
The claim map showing said claim(s) is filed
in the Linoln County, Wyoming records.
Recorder's Stamp
Name of claim(s) or site(s):
BLM Serial No(s)
Jiggs 5-22
Jiggs 24
WMC 294442-294459
WMC 294495
Attached is a check for $10.00 to cover the cost of and recording.
RECEIVED 8/29/2008 at 8:29 AM
RECEIVING # 941711
BOOK: 703 PAGE: 435
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
STATE OF Arizona
COUNTY OF Maricopa
Name and mailing address of owner or
claimant:
Mark S. Dolar
Moose Mountain Minerals, LLC
16815 E. Shea Boulevard, Suite # 110-172
Fountain Hills, Arizona 85268
Subscribed and sworn to by
Mark S. Dolar, Managing member of
Moose Mountain Minerals, LLC
(Owner, Claimant, Agent, or Lessee Signature)
tî 5 Befor}( m~ this
~day of ~S"C , 2008
By
, 2008
(~~ Wz. _
N TARY PUBLIC
e NOTARY PUBLIC
_ STATE OF ARIZONA
. Maricopa County
TIMOtHy JOSEPH W¡;IDlER
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