Chapter XXI: Appendix: #12

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Recorded at________o’clock______M.,_________________

Reception No._____________________________ Recorder.

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KNOW ALL MEN BY THESE PRESENTS: That,______________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________
the undersigned citizens of the United States, residents of

the County of_______________, State of________________________,
having complied with the provisions of Chapter 6, Title XXXII,
of the Revised Statutes of the United States, and with the
local customs, laws and regulations, claim by right of

discovery and location, The ___________________________________

placer claim, situate, lying and being in______________________

Mining District, County of_______________________, and State of

____________________, described by metes and bounds as follows,
to wit:

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

______________________________ area ____________________ acres,

said claim was located on the_______ day of__________, 19_____.

Date of certificate________________________, 19_____.

Attest:

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

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No. 161. PLACER LOCATION CERTIFICATE.--Bradford Publishing Co.,
1824–46 Stout Street, Denver, Colorado (573–5011)-–5–77