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Recorder'S Stamp: (Owner, Claimant, Agent, or Lessee)

This document is an affidavit and notice of intent to hold mining claim(s) and site(s) for the assessment year. It contains information about the owner or claimant, including their name and address. It also lists the claim and site names, BLM serial numbers, section/township/range locations, and the total number of claims being filed. The document is signed and notarized.

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joerocketman
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311 views1 page

Recorder'S Stamp: (Owner, Claimant, Agent, or Lessee)

This document is an affidavit and notice of intent to hold mining claim(s) and site(s) for the assessment year. It contains information about the owner or claimant, including their name and address. It also lists the claim and site names, BLM serial numbers, section/township/range locations, and the total number of claims being filed. The document is signed and notarized.

Uploaded by

joerocketman
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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The following Document contains no Personal Information

as defined by NRS 603A.040

AFFIDAVIT AND NOTICE OF INTENT TO HOLD


MINING CLAIM(S) AND SITE(S)

TO ALL WHOM IT MAY CONCERN:

The undersigned certifies that the owner or claimant intends to


hold the mining claim(s) for the assessment year ending
September 1, ______ (insert assessment year).
RECORDER’S STAMP

The claim map showing said claim(s) is filed in the County records. Claims are
generally located in Section(s):______ Township:_______ Range:_______

Name of claim(s) or site(s): BLM Serial No(s):

A total number of __________ claims is being filed with this document.

Name and mailing address of owner or claimant:


STATE OF
COUNTY OF

Subscribed and sworn to by

(Owner, Claimant, Agent, or Lessee)


Dated this day of_____________ , 20 .
before me this
day of , 20 .
By
Owner, Claimant, Agent, or Lessee Signature
(circle one)

Owner, Claimant, Agent, or Lessee Name


(printed)
NOTARY PUBLIC (Signature)

Suggested Form - Nevada Division of Minerals (REV. 8-27-2015)


Nevada Affidavit/Notice of Intent to Hold, NRS 517.230

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