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UNITED STATES <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. "\ J <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 fraudule t- t J <br /> s,or <br /> document with themBLM maytresultnel in a fine of up for which this w2aiver from prisonpayment <br /> men of the maintenance feesisrequested are: 401 l <br /> 7. The mining claims,mill or tunnel sitesPaY <br /> CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER <br /> 1. OPEN#1 CMC 245048 L.., <br /> CMC 245049 '`',- <br /> 2. OPEN#2 -- L,�y v <br /> 3. tr,01 <br /> i:-..c' <br /> 4. r, <br /> 5. (.i l <br /> 6. ,; . <br /> __ ;,,c.- <br /> 7. <br /> Ltd �,-4Y' <br /> 9. <br /> 10. <br /> The owner(s)(claimants)of the above mining claims and sites are: <br /> R.Stanley Pittman,Jr. _ �. '� 4._ <br /> (Owner's Name-Please Print) (Owne(s Signature) <br /> 902 Collins Road Colorado Springs CO 80920 <br /> (Owner's Mailing Address) (City) (State) (Zip Code) <br /> Sherryl K. Pittman ___ r• <br /> (Owner's Name-Please Print) (Owner's Signature) <br /> 902 Collins Road Colorado Springs CO 80920 <br /> (Owner's Mailing Address) (City) (State) . (Zip Code) <br /> Harriett J. Pittman <br /> /5 '---- � ._ z�\ NN. ,S, -.� <br /> (Owner's Name-Please Print) (Owner's '(nature) <br /> 902 Collins Road Colorado Springs CO 80920 <br /> (Owner's Mailing Address) (City) (State) (Zip Code) <br /> -ti , , c <br /> Amy R.Allmond 2-- ��l�l,v .- L , ..0 } i)P, ;ti <br /> (Owner's Name-Please Print) '" j *I.'D Ali"' (Owner's Signature) <br /> 902 Collins RoadColored•, prin•s 1611CO 80920 <br /> AP <br /> (Owner's Mailing Address) V I v. - so (State) (Zip Code) <br /> (Continued on page 2) a .,.'!A__. .1 • 1 " M <br /> L ..( farm. ► ` i ,.'.1 '6 <br /> . . . .■Igro- Z , , <br /> rte, w, eDF�_ �—► <br />