_ STATE OF________________________| | | SS. | COUNTY OF ______________________| Know All Men by These Presents, That ______________, the undersigned, ha____ this___________ day of________________, 19___, located and claimed, and by these presents do _____locate and claim by right of discovery and location, in compliance with the Mining Acts of Congress, approved May 10, 1872, and all subsequent Acts, and with local customs, laws and regulations, ____________________ linear feet and horizontal measurement on the ____________________________________________ lode, vein, ledge or deposit, along the vein thereof, with all its dips, angles and variations as allowed by law together with ________________ feet on the ________________ side and ________________ feet on the ________________ side of the middle of said vein at the surface, so far as can be determined from present developments; and all veins, lodes, ledges, or deposits and surface ground within the lines of said claim ________________ feet running ________________ from center of discovery ________________ and ________________ feet running ________________ from center of discovery ________________, said discovery ________________ being situated upon said lode, vein, ledge or deposit, and within the lines of said claim in _______________________________________ Mining District, County of ________________ and State of ________________ Discovered and located ________________________________, 19___ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ APPENDIX #3 ------------------------------------------------------------------------ [Illustration: APPENDIX #4] Form. 3400–11 UNITED STATES | Mineral Survey number (September 1967) DEPARTMENT OF THE INTERIOR | (formerly 4–683) BUREAU OF LAND MANAGEMENT |_________________________ | State | FIELD NOTES |_________________________ | Land District | _________________________________________________|_________________________ Of the Survey of the Mining Claim of (_name and address of Claimant_) ___________________________________________________________________________ Known as the (_name of group, if any_)