Chapter XIII: Appendix: #3

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Form. 3400–11 UNITED STATES | Mineral Survey number
(September 1967) DEPARTMENT OF THE INTERIOR |
(formerly 4–683) BUREAU OF LAND MANAGEMENT |_________________________
| State
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FIELD NOTES |_________________________
| Land District
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Of the Survey of the Mining Claim of (_name and address of Claimant_)

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Known as the (_name of group, if any_)

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CONSISTING OF LOCATIONS NAMED AND LOCATED AS FOLLOWS
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NAME OF LOCATION | DATE
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| LOCATED | AMENDED
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Mining district | County
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Section | Township |Range |Meridian | Survey under order dated
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Survey commenced |Survey completed | Name of Mineral Surveyor
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