HomeMy WebLinkAbout974468The following Document contains no Personal Information
as defined by NRS 603A.040
AFFIDAVIT AND NOTICE OF INTENT TO HOLD
MINING CLAIM(S) AND SITE(S)
TO ALL WHOM IT MAY CONCERN:
The undersigned certifies that the owner or claimant intended or
intends to hold the mining claim(s), mill site(s), and/or tunnel
site(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.
The claim map showing said claim(s) is filed in the 1_,./veoi-Ai
I A
Nam- o c a 6r eks d v
P9- 3
A total number of vR claims is being
filed with this document.
STATE OF W c) oft i trt
COUNTY OF Li d1(_0 1 v
Subscribed and sworn to by
5 c cc r� lY\ e i C h a�>>t k v -1
(Owner, Claimant, Agent, or Lessee)
before me this i(1
day of i),i ,20
JANET PAULSON NOTARY PUBLIC
County of
Lincoln
State of
Wyoming
My Commission Expires
NOTARY PUBLIC (Signature)
Name and mailing address of owner or claimant:
/557 212 Ldp K57-79
ri'e- Z1 7
Dated thi g day of /040157 20 4
By 7(,/
wner, Claimant, Agent, or Lessee Signature
r 'r.SI- PZ/
Owner, Claimant, Agent, or Lessee Name (printed)
RECEIVED 12/11/2013 at 10:43 AM
RECEIVING 974468
BOOK: 825 PAGE: 175
JEANNE WAGNER
LINCOLN COUNTY CLERK, KEMMERER, WY
RECORDER'S STAMP
County records.
BLM Serial No(s):
WM& 3 orN4