Form Yg(5047eq) F1 - Application For A Fractional Claim

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Office Use Only

Energy, Mines and Resources

QUARTZ MINING ACT FORM 2 SECTION 44

APPLICATION FOR A FRACTIONAL CLAIM

_____________________________________________________________________________________ Mining District

Office Date Stamp

I, _____________________________________________________________________________________________,

Occupation _____________________________________________________________________________________of

Postal Address ___________________________________________________________________________________

____________________________ Phone Number (____)_____________ , Client I.D. Number ____________________ ,

make oath and say that:

At the hour of * _______________________________________ on the _________________ day of ______________________________________ , 20 ___________ ,

I located the ________________________________________________________________________________________________ mineral claim, situated on Claim

(Claim Name)

Sheet no.: _______________________________________________________________ Tag Number _____________________

Described Area: _______________________________________________________________________________________________________________ _________

(Sketch of group required showing position of claim as nearly as possible, direction of location line and name(s) of any claim(s) it may adjoin)

This is a fractional claim bounded on the North by _______________________________ on the South by ________________________________ on the East by

(Tag Number)

_______________________________ on the West by _______________________________ and is more particularly described on the sketch plan on the back of

(Tag Number)

(or attached to as the case may be) this declaration.

I have placed posts of legal dimensions with the tag clearly inscribed and affixed on each post as prescribed by the Quartz Mining Act.

I have inscribed on the tag for location Post No. 1: Claim Name and Number: ________________________________________________________________________

Staked By: ____________________________________________________________________________________ Staking Date: ________________ ____________

Direction: ______________________________________________________________________ Left: ______________________ Right : ______________________

I have inscribed on the tag for location post No. 2: Claim Name and Number: _________________________________________________ _______________________

Staked By: ____________________________________________________________________________________ Staking Date: _________________ ___________

_________________________________________________ Direction:

Witness Post Distance:

The length of the location line is approximately ____________________________________________________________________ feet.

I have marked the line between post No. 1 and post No. 2 as required by section 31 of the Quartz Mining Act.

To the best of my knowledge and belief the ground comprised within the boundaries of the said claim is unoccupied and unrecorded by any other person as a mineral

claim; it is not occupied by any building or any land falling within the curtilage of any dwelling house or any land under cultivation or any land rserved from entry under

the Quartz Mining Act.

The said claim has not heretofore been staked out by any one in my interest.

Sworn before me at ________________________________________________________________ this ___________ day of __________________________ 20 ________

_________________________________________________

Notary Public

Applicant

* Should be shown when possible

Access to Information and Protection of Privacy Act

The personal information requested on this form is collected under the authority of and used for the purpose of administering the Quartz Mining Act.

Questions about the collection and use of this information can be directed to the Mining Recorders Office, Mineral Resources, Department of Energy, Mines and Resources,

Yukon Government, Box 2703, Whitehorse, Yukon Territory, Y1A 2C6 (867) 667-3190

YG(5047EQ)F1 Rev.01 2012

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