Form 3830-4 - Affidavit Of Annual Assessment Work
Download a blank fillable Form 3830-4 - Affidavit Of Annual Assessment Work in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form 3830-4 - Affidavit Of Annual Assessment Work with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4c
FORM APPROVED
UNITED STATES
Form 3830-4
OMB NO.: 1004-0114
(January 2017)
DEPARTMENT OF THE INTERIOR
Expires:
January 31, 2020
BUREAU OF LAND MANAGEMENT
AFFIDAVIT OF ANNUAL ASSESSMENT WORK
WHEN RECORDED, MAIL DOCUMENT TO:
NAME:
________________________________________
ADDRESS:
_____________________________________
CITY, STATE, ZIP: _
__________________________________
FOR COUNTY RECORDER’S USE
No. of Claims ________
_______
x $10/claim
Total due BLM $ ___
_________
TO ALL WHOM IT MAY CONCERN:
1. The undersigned certifies that at least $100 per claim was expended for development, labor and
improvements, or equivalent value added, as the annual assessment work for the assessment year ending
September 1,
_______
for the following contiguous unpatented mining claim(s), located in the County of
______________________, in the State of __
______________
________.
Tp
Rg
Sec
Mer
County Recordation
Co. Recording
BLM Serial No.
Name of Claim
Example: 13N 5E 14 MDM
Book and Page No.
Date
_______________________________________________________________________________________________________________________________________
(Continued on page 2)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal