2012-04-19_REPORT - M1977004 ‎(2)‎

• Permit No: M1977004
• IBM Index Class Name: REPORT
• Doc Date: 4/19/2012
• Doc Name: ANNUAL FEE/REPORT
• From: HOMESTAKE MINING COMPANY
• To: DRMS
• Email Name: RCO
• Media Type: D
• Archive: No

CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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t State cf California
County of C0 7 Qtl C.,-/ A 1 ss.
On J✓rti iq YCb,
c
personally appeared
MATTHEW TAYLOR
• •` Commission N 1232691 a
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MY ardm..stptmAugalazo
Pbae notary Octal Remre
Document Date:
before me, Ml 1ri-/ '"} wiZ 40774-i2t' IrrBL►
Mau mei T e of Ctie• (a.J. 'Jam nea. Natra•r Pubic')
T. 14. Wcr4 C-
namolst of d:rmnol
.personally known to me
L proved to me on the basis of satisfactory
evidence
10 be the personN whose namets.) is/ace—
subscribed to the within instrument and
acknowledged to me that he/she ey led
the same e in his/herftheir authorized
capacity(i
), and that by hi t
signatu
rn(±y, on the instrument the person, or
the entity
upon behalf of which the person(s), acted,executed
the Instrument.
my hand - • : • facial seal.
.il.
l sty Pa da
OPTIONAL
Though the information below is not required by low, if may prove valuable ro person, relying on :ha doetrmont
and could prevent fraudulent removal and reaMachn,ent 01 this form to aneehor daeum:nf.
Description of Attached Document
Title or Type of Document: L taKetildr y c Pfii -rt Su2C /
Number of Pages:
Signer(s) Other Than Named Above:
Capacity(ies) Claimed by Signer
Signer's Name:
❑ individual
o Corporate Officer — Titie(s):
o Partner - 0 limited 0 General
Li Altorney in Pact
O Trustee
O Guardian or Conservator
O Other:
Signer Is Representing:
•
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