Chapter XI: Appendix: #1

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Form 3860–6 UNITED STATES | Place
(October 1976) DEPARTMENT OF THE INTERIOR |_________________________
(formerly 3400–7) BUREAU OF LAND MANAGEMENT |
| Date
ORDER FOR MINERAL SURVEY |_________________________

To Mineral Surveyor:
__
|

Sir:

Application has been filed in this Office by

, dated , 19 .

for an official survey of the mining claim consisting of locations named,
located, and recorded as follows:
___________________________________________________________________________
Group name, if any

___________________________________________________________________________
| DATE |
|____________________________________|
NAME OF LOCATION | | | | AMENDED
| LOCATED | RECORDED | AMENDED | RECORDING
______________________|___________|____________|___________|_______________
| | | |
| | | |
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| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
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| | | |
| | | |
| | | |
______________________|___________|____________|___________|_______________
Mining District | County | State
| |
______________________|________________________|___________________________
Section | Township | Range
| |
______________________|________________________|___________________________
Meridian | National Forest
|
__________________________________|________________________________________

The claim is fully described in the certified copy of the location
certificate filed by the applicant for the survey, copy of which is
enclosed herewith. You are hereby directed to make the survey of said
claim in strict conformity with existing laws, official regulations, and
instructions thereunder, and make proper return of the survey to this
Office.

This survey will be designated as Mineral Survey Number

Very truly yours,

__________________________________________

(Authorized Signature)

__________________________________________

(Title)