Chapter XV: Appendix: #5

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Form 3860–8 UNITED STATES | Serial Number
(February 1977) DEPARTMENT OF THE INTERIOR |
BUREAU OF LAND MANAGEMENT |
|_______________________
CERTIFICATE OF EXPENDITURES, IMPROVEMENTS, | Date
AND MINERAL SURVEY |
___________________________________________________|_______________________
Name of Claimant | Mineral Survey Number
|
|
___________________________________________________|_______________________
|
I HEREBY CERTIFY That the | I FURTHER CERTIFY That the
|
record of the above-described | record reveals not less than $500
|
mineral survey furnishes such an | worth of labor has been expended for
|
accurate description of all claims | improvements upon or for the benefit
|
embraced within the survey that it | of each of the lode claims embraced
|
will, if incorporated into a patent, | within the survey and that the
|
serve fully to identify the premises | improvements were made by the
|
and that references are made in the | claimant or his grantors.
|
survey to natural objects or |
|
permanent monuments so that the |
|
location of the claims will be |
|
perpetuated and fixed. |
|
_____________________________________|_____________________________________
Date | Authorized Signature
|
|
|
________________|__________________________________________________________

(_See reverse_)
APPENDIX #6

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Form 3400–5 UNITED STATES | Place
(December 1966) DEPARTMENT OF THE INTERIOR |_____________________________
(formerly 4–286a) BUREAU OF LAND MANAGEMENT |
| Date
|_____________________________
|
| INSTRUCTIONS
|
| The Director, Bureau of Land
| Management, and the manager
APPROVAL OF MINERAL SURVEY | of the appropriate land (or
| land and survey) office must
| be notified of the approval
| of each mineral survey,
| using this form.
_____________________________________________|_____________________________

_____________________________________

_____________________________________

SIR:

The following described mineral survey was approved on , 19 :
___________________________________________________________________________
SURVEY NUMBER | NAME OF CLAIM | ACRES
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________
| |
______________|_________________________________________________|__________

This survey is actually in conflict with the following approved mineral
survey(s) listed by name and number, as marked, defined, and established on
the ground

___________________________________________________________________________
Applicant for survey (_name and address_)

___________________________________________________________________________
Survey made by , Mineral Surveyor.

___________________________________________________________________________

The following legal subdivisions are covered in whole or in part by this
survey, if situated on surveyed lands

___________________________________________________________________________

The survey is shown on the diagram below, sketched as actually marked,
defined, and established on the ground with respect to the lines of the
public land surveys; data relating to courses and distances have been
omitted.

___________________________________________________________________________

NOTE -- This sketch will be made in each case where upon surveyed land,
whether or not there are any conflicting approved mineral surveys.
Conflicting mineral surveys, however, will not be shown upon the sketch.
___________________________________________________________________________

Section , Township , Range Section , Township , Range

_____________________________________ ____________________________________

(Title)
___________________________________________________________________________