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i <br />2 (Form i <br />a la?? <br />North <br />T-OWNSHIP (write number and check direction) T <br />R East est <br />ction <br />RANGE (write number and check dire NE NW SE SW <br />QUARTER SECTION (check one),." <br />ne): NW SE .SW <br />NE <br />QUARTER/QUARTER SECTION (check one): <br />GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the approximate elevation): <br />16 . ft q6 a) <br />W <br />UCI`G <br />NOTE: Supply longitude and latitude or UTM coordinates if lands have not been surveyed or adsupplemental information to <br />thi? is NOI'• GPS.measurements will be acceptable for this purpose: <br />_ r , utv?lTf? <br />&4 <br />Cl ' <br /> <br />1) AV) <br /> <br /> <br />i 7-60NsRip <br />6. LAND OW ERSHIP National Forest (USFS) <br />Private Public Domain (B lease describe): <br />State Sovereign Lands Other (p <br />State <br />remaining section must be completed.) prospecting is located on BLM or USFS land the otherwise go to section II Maps & Drawings <br />7. <br />LAND d into cooerative agreements that eliminate the The Division and the BLM/USFS have end re them to coo d nate the review of the NOIin order d to for a minimize radministrative <br />allow <br />financial warranty with each agency and <br />processing time and effort. <br />A. CLAIMANT: <br />Name: ? I ?J.?}"U4 <br />Address:____ ?_ <br />.? <br />Telephone: <br />Fax Number: <br />B. SITE/CLAIM INFORMATION: <br />List names, serial numbers and provide legal description to nearest quarter-quarter section of all sites or claims (attach <br />additional page, if necessary). <br />NAME SERIAL NUMBER LEGAL DESCRIPTION <br />e <br /> <br />M 4}