Voluntary - 43 Cfr 3809 Exploration Notice Form - United States Department Of The Interior

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Voluntary – 43 CFR 3809 Exploration Notice Form
United States Department of the Interior
BUREAU OF LAND MANAGEMENT
Royal Gorge Field Office
3028 East Main Street
Cañon City, Colorado 81212
DATE FILED:
*Please indicate any fields you feel are confidential information.
Fields highlighted in yellow are not likely to be applicable to a small miner (dredge/highbank).
Section 1: Operator/Claimant Information
Pursuant to 43 CFR 3809.301(b)(1).
1. Operator Information
Operator Name: _______________________________________________________________________
Mailing Address: _______________________________________________________________________
City: State: ZipCode: __________________________________________________________________
Phone #: _______________________________Alternate Phone #:_______________________________
Operator Tax Payer Identification Number:__________________________________________________
2.
Claimant/Claim
Information, if applicable; if open minerals check here
Primary Claimant: ______________________________________________________________________
Mailing Address: _______________________________________________________________________
City: State: ZipCode: __________________________________________________________________
Phone #: _______________________________Alternate Phone #:_______________________________
Additional claimant name(s), if applicable: __________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Claims Information: Please list the CMC numbers, claim names, and claim type (i.e. placer, lode, mill site,
tunnel site) for all claims involved in the proposed operations.
CMC
Claim Name
Claim Type
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