Mining Form Mr-700 - Land Entry Agreement For Land Leased By Mine Operator (Page 3 of 3) in pdf

Mining Form Mr-700 - Land Entry Agreement For Land Leased By Mine Operator Page 3

Permit No.____________

IN THE PRESENCE OF:

________________________________(w3)

FOR THE LESSOR:

(witness 3)

________________________________(w4)

___________________________________________

(witness 4)

(Lessor signature)

___________________________________________

(Lessor printed name and title)

___________________________________________

(Lessor Company)

Address: __________________________________________

___________________________________________

Telephone:____________________

STATE OF SOUTH CAROLINA

)

COUNTY OF __________________

)

PERSONALLY appeared before me ________________________________________________(w3) and made oath

that ______ he saw the within-named ________________________________________ sign, seal, and as _____ (his or her)

(lessor)

act, deliver the within-written Land Entry Agreement for land leased by Mine Operator for the uses and purposes therein

mentioned and that _______he with ____________________________________(w4) witnessed the execution thereof.

_____________________________________________________

(signature of witness w3)

SWORN to before me this _____day of__________________, 19____.

___________________________________________

NOTARY PUBLIC FOR SOUTH CAROLINA

My Commission expires: ______________________

DHEC 3105 (08/1997)

Page 3 of 3

Mining Form Mr-700 - Land Entry Agreement For Land Leased By Mine Operator Page 3