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Notice of Intent No.: _________________________ Date: __________________________ <br />Project Name: ____________________________________________________________________ <br />Prospector: _____________________________________________________________________ <br />Address: _____________________________________________________________________ <br /> <br /> _____________________________________________________________________ <br /> <br /> _____________________________________________________________________ <br />County: ____________________________ <br />Name of Drilling Contractor: ______________________________________________________ <br />License of Drill and Rig: ______________________________________________________ <br />(Continued on Next Page)