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2 (Form 2- Public) <br />TOWNSHIP (write number and check direction) T~ iv'orth_~ South <br />RANGE (-szite number and check direction} R~East West <br />QUARTER SECTION (check one): -NE _~N~V SE SW <br />QUARTER./QUARTER SEC'CiON (check one): I~rE NW SE SW <br />GENERAL DESCRIPTION: (the number o€miles and direction to the nearest town and the approximate elevation): <br />~~v;,o~ /~ /l/J <br />NOTE: Supply longitude and latitude or [3"Tbi coordinates if lands have not been surveyed or as supplemental information to <br />this NOL GPS measurements wilt be acceptable for this purpcue: ,(~ !~. n ` .SS/ , ,~ Z • G S ~' <br />6. LAND oWNF.RSxIP <br />Private Public Domain (BLM} National Forest (USFS) _l <br />State State Sovereign Lands Other (please descnbe): <br />If prospecting is located on BLM or USFS land the tretnaining section must be rnmpleted, <br />otherwise go to section ii Maps & Drawings <br />1. PROSPECTIlYG ON BURE.~-U OF LAND MALYAGEI~NIT (BLIb[} LAi~ID AND U.S. FOREST SERVICE fUSF'Sl <br />LAND <br />The Division and the BLMfUSFS have entered into cooperative amts that eiitninabe the need for a prospector to post a <br />I amity with each agency aml allow them oa ooa~rdinate the review of the NOI in order to minimize administrative <br />processing time and effort. <br />A. CLAIMANT: <br />Name: ~s~o `J,viv~- ~'~~si~~ Y <br />Address: ~lT'-Q~ ~` .t~oi'7.y ~6~~/,~~'1~>c~ <br />Telephone: 'xjrJ - S"./t~ '~~' <br />Fax Number: <br />8. SITElCLAIIVIINFORMATION: <br />List names= serial tttunbets and provide Legal description m nearest quarter-gaarter section of. aii sites or claims (attach <br />additional page, if necessary). <br />NA~~rIE SERIAL NU~+iBER LEGAL DESCRIPTION <br />