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2 (Form 1 - All information for DBMS use and confidential filing) <br />TOWNSHIP (write number and check direction) T w North South _ <br />RANGE (write number and check direction) R_ _East AV West w_ <br />QUARTER SECTION (check one):_ NE WNW SE SW _AW QUARTER/QUARTER SECTION (check one):-J E „_?NW _.AV_SE _AVSW <br />GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the aDDroximate elevationl- <br />NOTE: Supply longitude and latitude or UTNi coordinates if lands have not been surveyed or as supplemental information to <br />this NOL GPS measurements will be acceptable for this purpose: <br />6. LAND O`VNERSHIP <br />Private Public Domain (BLM) y National Forest (USFS) <br />State State Sovereign Lands ---.Other Other (please describe): <br />If prospecting is located on BLM or USFS land the remaining section mast be completed, <br />otherwise go to section II Maps & Drawings <br />7. PROSPECTING ON BUREAU OF LAND MANAGEMENT (BLMI LAND AND U S FOREST SERVICE (USFS) <br />LAND <br />The Division and the BLNIIUSFS have entered into cooperative agreements that eliminate the need for a prospector to post a <br />financial warranty with each agency and allow them to coordinate the review of the NOI in order to minimize administrative <br />processing time and effort. <br />A. CLAIMANT: <br />Name: Ujnrmi?.Ti amn ®,*,e t164, z ie- <br />Address:'/?o Telephone: <br />Fax Number: _ L?/ /n Lfl? ?? y <br />B. SrI'E/CLALXIIN.F'ORIMATION: <br />List flames, serial numbers and provide legal description to nearest quarter-quarter section of all sites or claims (attach <br />additional page, if necessary). <br />NAME <br />SERIAL NUMBER <br />LEGAL DESCRIPTION