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t.' ;1TED S- AJ'ES TORM APPR(WED <br />DE.PAR "1'11ENT OF THE INTERIOR Joyce M. ROD Chaffel County Clerk <br />BUREAU OF I A':D Reception 0: 413736 <br />-' Papse Reeprded: M of p Recording Fee: 111.26 <br />AFFIDAVIT OF AN\CAL ASSESSMENT VVC( 0ocument Type: A ONEO <br />Oats Recorded: 4/28/2011 2061 PM <br />'WHEN RECORDED. MAR AR DOCUMENT TO: RECORDS UPDATED <br />VD 4"q! <br />.._._._ 39& _•______ 638" <br />480 481 <br />L <br />,. DDF—E" �f % _ _ For , c�1 seI'16 Yr <br />CI! ,'. ST. =.;E <br />Joyce M. Reno Chsffes County Clerk <br />Reception e: 409754 <br />?spec Recorded: i of 3 Recording Fee: 116.25 <br />document Type: AFFIA <br />Ate Recorded: 8/231xO13 a200C AM <br />ti� HU�1 11' �1A1' CON <br />Cl* I <br />l <br />:t(_c <br />Itia +sl . -Date '- <br />OR'COUNTY Rr_CORDER'S USE <br />No. of Claims <br />'x $1016aim or site <br />Total due BLM S 10. C)o <br />1. The undersigned, certifies that at least $100 per cla.un was expended for development, labor and improvements, or <br />equivalent value added, as the annual assessment work for the assessment year en September 1, o?�. for the <br />f Rowing cgntiguous unpatented mining claim(s), located in the County of _� Q in the State of <br />Ora QQ <br />BLM Serial No. <br />Name of Claim <br />Tp Rg Sec Mer <br />Example: 13N 5E 14 MDM <br />County Recordation <br />Book and Page No. <br />Date <br />Q15 L+4 <br />e <br />_ <br />hp IJ519 <br />RK Al- <br />C1 <br />775. <br />i <br />�n <br />u <br />— <br />- > <br />Cn <br />2. Type of labor and improvements (specify what was done and give the total value for that labor and improvement to <br />show at least $100 for each claim). If a geological, geochemical, or geophysical sur-,•ey was performed, as er 30 <br />U.S.C. 28 -1, reference the title of the report of survey, give cost and date of the survey and report; and indicat was <br />(\ filed with the County Rpoorder: ' A / <br />T <br />Description of Work Performed <br />Value of Work <br />Performed <br />Date WoA VYS <br />P d <br />RK Al- <br />t.-J <br />7 4T <br />I <br />