Location Notice For Mining Claim Form Page 2

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Name__________________________________________
_______________________________________
Address________________________________________
(Signature)
__________________________________________________________
Name__________________________________________
_______________________________________
Address________________________________________
(Signature)
_______________________________________________
Name__________________________________________
_______________________________________
Address________________________________________
(Signature)
_______________________________________________
Name__________________________________________
_______________________________________
Address________________________________________
(Signature)
_______________________________________________
Name__________________________________________
_______________________________________
Address________________________________________
(Signature)
__________________________________________________________
6. AFFIDAVIT OF LOCATOR
STATE OF
COUNTY OF
, SS.
I,
, DO SOLEMNLY SWEAR THAT I AM A CITIZEN OF THE UNITED STATE OF AMERICA (OR HAVE DECLARED MY
INTENTION TO BECOME SUCH), AND THAT I AM ACQUAINTED WITH THE MINING GROUND DESCRIBED IN THIS NOTICE OF LOCATION, AND
HEREWITH CALLED THE
LODE/PLACER CLAIM OR SITE; THAT THE GROUND AND CLAIM/SITE THEREIN
DESCRIBED OR ANY PART THEREOF HAS NOT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, BEEN PREVIOUSLY LOCATED ACCORDING TO
THE LAWS OF THE UNITED STATES AND THIS STATE, OR IF SO LOCATED, THAT THE SAME HAS BEEN ABANDONED OR FORFEITED BY
REASON OF THE FAILURE OF SUCH FORMER LOCATOR(S) TO COMPLY IN RESPECT THERETO WITH THE REQUIREMENTS OF SAID LAWS.
SIGNATURE _______________________________________________
State of_____________________
Subscribed and sworn to (or affirmed) before me
County of ___________________
this ________day of ____________________, 20____.
(Seal)
__________________________________________________
Notary Public
or County Recorder
(my commission expires _____________)

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