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Y .=),oOat05)9 <br /> UNITED STATES i <br /> Form 3830-2 DEPARTMENT OF THE INTERIOR <br /> (January 2017) BUREAU OF LAND MANAGEMENT FORM APPROVED <br /> MAINTENANCE FEE WAIVER CERTIFICATION OMB NO. 1004-0114 <br /> Expires: January 31,2020 <br /> SEE INSTRUCTIONS ON PAGE 2 <br /> 1. This small miner waiver is filed for the assessment year beginning on September 1, 2017 and ending on September 1, 2018 . <br /> 2. The undersigned and all related parties owned ten or fewer mining claims,mill,or tunnel sites located and maintained on Federal lands in the United States <br /> of America on September 1,2017 <br /> 3. The undersigned have performed the assessment work required by law for each mining claim listed prior to filing this waiver and understand that by filing this form, <br /> the undersigned must file an affidavit of assessment work with the Bureau of Land Management(BLM)by the December 30th following the filing of this waiver. <br /> 4. The undersigned understand that if the assessment work obligation has not yet come due under 30 U.S.C.28(for those claims in their first assessment year only), <br /> a notice of intent to hold reciting this condition must be recorded by the December 30th following the filing of this waiver. <br /> 5. The undersigned understand that mill and tunnel sites may also be listed on this waiver and be waived from payment of the maintenance fee,and that a notice of , <br /> intent to hold for these sites is required to be filed with the BLM by the December 30th following the filing of this waiver. 1°.` <br /> 6. The undersigned understand and acknowledge that pursuant to 43 U.S.C.1212 and 18 U.S.C.1001,the filing or recording of a false,fictitious,or fraudulent <br /> document with the BLM may result in a fine of up to$250,000,a prison term not to exceed five years,or both. 90()\-\ <br /> 7. The mining claims,mill or tunnel sites for which this waiver from payment of the maintenance fees is requested are: <br /> CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER <br /> 1. Ore^ I ` C"tC 1111-by1 <br /> 2. O p eq 2 - Ci1C-- 7-Ys-Ott 9 <br /> 3. <br /> 4. <br /> 5. `) <br /> r.,,1 Ono <br /> d r-C <br /> 6. ..;-.1 O <br /> 7. C -+>Q <br /> �J -4 rn <br /> il <br /> 8. `..1/4, r.10--4 , <br /> -•• p C <br /> 9. <br /> 10. r- (,�o.... <br /> The owner(s)(claimants)of the above mining claims and sites are: ! O -' u <br /> Col le <br /> j Co /&4 <br /> 1 . fr-4� <br /> :z1 <br /> (Owier's Name-Please Print) (Owner's Signature) <br /> •2 f C t c1 S.1 4-'D c=ix- el Co fa61( <br /> (Owner's Mailing Address) (City) (State) (Zip Code) <br /> Ala#4..) boy, -- ___._ <br /> (Owner's Name-Please Print) (Owner's Signature) <br /> (Owner's Mailing Address) (City) (State) (Zip Code) <br /> (Owner's Name-Please Print) (Owner's Signature) <br /> (Owner's Mailing Address) (City) (State) (Zip Code) <br /> RECORDS UPDATED <br /> (Owner's Name-Please Print) Action wner`signature) <br /> For ao( Assessment Year <br /> (Owner's Mailing Address) . (City) (State) (Zip Code) <br /> iii,(Continued on page 2) <br /> Initials c Date O ( 3 r <br />