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u ~va/~v v~'v~a~u mni~nason~a~a ~ VMU MI. IVIpV~N <br />MAINTENANCE FEE PAYMENT WAIVER CERTIRCATpN B"~a ~' 1999 <br />1Lia small miner waiver is filed m hdd the da6ns/artea Bated below for the assesstoem ear <br />_ ---- y b~tmmg at noon on the firms Sepoembu 1 folbwing th <br />off~ial SGog of this Cmm with BLM. <br />The uadeta~ned owvet~ of the mining d®matsites Geed bektw hneby catity ender pmaty of 18 U.S.C. 1001 and 43 U.S.C. 1212 tbaC <br />~P'e tE~ or will cootmL ten or fewer mining daima/aitea lacsad and momamed ao Federal land in the Unified State of Ametica ~ the Angus 3 <br />that is day before the beginning of the ssaeasmmt yeu indicated in line one above. <br />~/W~'fuv}twit} p f~a fpaiorm asaessncat work t~ the daims Gated below 6oc~thc a~siea[ usessmeat year~as of the August 31 i~icatedm Gn <br />three e. 7fiis wrotlc maeets the tequircaxna of the General Minivg Law of 1672,~as mnertdad: the Aa of August 1Q I993; ant the rcguatiom et 4 <br />CPR 3833 and 3850. Such work wi0 be desatbed oa our af5davit d Tabor. Listia~ a ®b oo this farm cooatimies a Sling of a Notice of asenrim to Hot <br />for tbat site. 1 eacbae a 55.00 per site service ctuage (retxadvtg f«) far each she head. - <br />^ Pleose chat ttla boz itthe b®owbag alateaamtt appBea a you. ~.S' ~ <br />f/Wt nitywfdt asy/ow elaian med/or silea arof lisard iiele,r. <br />The mining der®s and sites for which the above waiver fmm payment of fie mamtenaace fem is made arc <br /> ------ -- CLAIM NAME BLM RHCORDA7ION St3RIAi, NUMBER <br />F i-, ~~ - y~35 ~ / <br />~ vI -1~~'c •t~~ . 3 f~c - s~ 83,5: <br />~= ^v; -/..,Jilt ~c>. g d C~~ - ~~~"~w z ~ <br /> <br />~' i,JLG'E SiyJL'.(' C/y/C ~iJp9/~ c/ <br />~. s~~t-y N~~X ~ ~~ - z s ~ 9i ~ v <br /> S~rKy ~~tJz~~~ ~ Cf~I< J~~~~9~v <br />g• ~z u /'7'G'IP~y C~y/< - 2 5 / 7/ Z v <br /> <br />I¢. <br />AG ownet(a} of the above milting deltas and sites are BGoa far this waiver. . <br />QWeunderstand a~ aclmowkdge that puwttmt m 43 US.C. t212 awtd 1$ [JS.C: 10(11, the tiGttg of <br />Bttreauof [.and Management may reach m a fine of up to S10A00, a psiaaa Germ anew eaaxyd'~trq~a <br />,f--- --- (owner's Nwe - Please Print) <br />Al 29ti'~ CPdar Hc°lgdfS (~,^iVe <br />(Sheet Q P.ff. Boa) <br />(Owner's Name - Please Print) <br />(Seca err P.O. Hoer) <br />(Owner's Name -Please Riot) <br /> <br />a frrtmtlmt document with th <br />CO 8a9a <br />(~D GS. Coda) <br />~~ <br />(Owners Signature) <br />(Ciry)_ (sate>- -- lCp+al . <br />(Owners Signatnrc) <br />(Ci4') <br />rr5 =ll U~ h I ~~1~ lt~l <br />(Owners Name -Please Print) ~1 ~ r~ (Owttet' <br />_.._ iJ~'V ~ Ld ~ ~ O.J <br />_ ,n:~ , <br />(Street or P.O. Boz) , . ~.~ J ~ (City) <br />(Staa)_ (I~~Cudat_' <br />Sigttaatrc) <br />--~ (State) (Zip Code) <br />