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11. <br />2 (FORM 2 - Public filing) <br />RANGE (write number and check direction) R71 East West n <br />QUARTER SECTION (check one): I l NE NW i--1 SE v SW <br />QUARTER/QUARTER SECTION (check one)- NE u NW SE SW <br />GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the approximate elevation): <br />1.5 MILES NORTH OF LAKE GEORGE <br />NOTE: Supply longitude and latitude or UTM coordinates if lands have not been surveyed or as supplemental information to <br />this NOL GPS measurements will be acceptable for this purpose: <br />RSHIP ❑ <br />Pate ■ Public Domain (BL National Forest (USFS) ✓ <br />S to ■ State Sovereign Lands Other (please describe): <br />If prospecting is located on BLM or USFS land the remaining section must be completed, <br />otherwise go to section II Maps & Drawings <br />12. PROSPECTING ON BUREAU OF LAND MANAGEMENT (BLM) LAND AND U.S. FOREST SERVICE (USFS) <br />The Division and the BLM/USFS have entered into cooperative agreements that eliminate the need for a prospector to post a <br />financial warranty with each agency and allow them to coordinate the review of the NO! in order to minimize administrative <br />processing time and effort. <br />G. CLAIMANT: <br />Name: MICHAEL D ROYER <br />Address: PO BOX 23 <br />VILLA GROVE, CO 81155 <br />Telephone: 9704700973 <br />Fax Number: <br />H. SITE/CLAIM INFORMATION: <br />List names, serial numbers and provide legal description to nearest quarter -quarter section of all sites or claims (attach <br />,additional page, if necessary). <br />NAME SERIAL NUMBER LEGAL DESCRIPTION <br />L.G.P.D.#2 CMC269321 SW1/4 OFSE1/4 OF S17,T12S,R71W <br />N.M PM ,PARK COUNTY <br />