Assignment Of Prospecting Lease Form Page 2
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AFFIDAVIT OF ASSIGNEE
I, ____________________________________________________________________________________ of
_______________________________________________ in _______________________ make oath and say:
1. THAT I am the Assignee named in the within instrument.
2. THAT it is my intention to thoroughly prospect the lands described in the said Prospecting Lease number
_____________________________________ in accordance with the Placer Mining Act and Guidelines; and
3. THAT I am capable of financing the expenditure necessary to thoroughly prospect the said lands in
accordance with the said Act and said Guidelines;
4. THAT I undertake to complete the approved program, or submit a detailed revised program (attached) for your
consideration.
Sworn before me at __________________________ this _____ day of ____
___________________ 20 ____ .
_____________________________________
______________________________________
Notary Public
Assignee
AFFIDAVIT OF WITNESS FOR ASSIGNOR
I, ____________________________________________________________________________________ of
_______________________________________________ in _______________________ make oath and say:
1. THAT I was personally present and did see the within instrument duly signed, sealed and executed by
____________________________________________________________________ the Assignor(s) hereto;
2. THAT I know the said Assignor(s) and am satisfied that he is (they are each) of the full age of eighteen years;
3. THAT the said instrument was duly executed at _______________________________________________
in ________________________________________________________________________________ ; and
4. THAT I am subscribing witness to the said instrument.
Sworn before me at __________________________ this _____ day of ____
___________________ 20 ____ .
_____________________________________
______________________________________
Notary Public
Witness
AFFIDAVIT OF WITNESS FOR ASSIGNEE
I, ____________________________________________________________________________________ of
______________________________________________________________________________________ in
make oath and say:
1. THAT I was personally present and did see the within instrument duly signed, sealed and executed by
_____________________________________________________________________ the Assignee hereto;
2. THAT I know the said Assignee(s) and am satisfied that he is (they are each) of the full age of eighteen years;
3. THAT the said instrument was duly executed at _______________________________________________
in ________________________________________________________________________________ ; and
4. THAT I am subscribing witness to the said instrument.
Sworn before me at __________________________ this _____ day of ____
___________________ 20 ____ .
_____________________________________
______________________________________
Notary Public
Witness
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