HomeMy WebLinkAbout978191The following Document contains no Personal Information
as defined by NRS 603A.040
AFFIDAVIT AND NOTICE OF INTENT TO HOLD
MINING CLAIMS) 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.
RECORDER'S STAMP
The claim map showing said claim(s) is filed in the 4A/C'o.1- County records.
Name of claim(s) or site(s):
9 A
A total number of
filed with this document.
1
claims is being
C Name and mailing address of owner of claimant:
�>1i15ft//• Ch1
,mod/ /3
Kk-74 4q0,--C-75/2,
c 9(UJ
Dated this
7
day of
20
Owner, Claiman "Agent, or Lessee Signature
o 4
Owner, Claimant, Agent, or Lessee Name (printed)
BLM Serial No(s):
/�Jm '30875
STATE OF YOM; n
COUNTY OF i
Subscribed and sworn to by
SA s n
(Owner, Claimant, Agent, or Lessee)
bef9ce me this
day of Ut- 20M
CHRISTY MISPLAY
County of
Lincoln
My Commission Expires
NOTARY PUBLIC
State of
Wyoming
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