The following described mineral survey was approved on , 19 : ___________________________________________________________________________ SURVEY NUMBER | NAME OF CLAIM | ACRES ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ | | ______________|_________________________________________________|__________ This survey is actually in conflict with the following approved mineral survey(s) listed by name and number, as marked, defined, and established on the ground ___________________________________________________________________________ Applicant for survey (_name and address_) ___________________________________________________________________________ Survey made by , Mineral Surveyor. ___________________________________________________________________________ The following legal subdivisions are covered in whole or in part by this survey, if situated on surveyed lands ___________________________________________________________________________ The survey is shown on the diagram below, sketched as actually marked, defined, and established on the ground with respect to the lines of the public land surveys; data relating to courses and distances have been omitted. ___________________________________________________________________________ NOTE -- This sketch will be made in each case where upon surveyed land, whether or not there are any conflicting approved mineral surveys. Conflicting mineral surveys, however, will not be shown upon the sketch. ___________________________________________________________________________