EXAMPLE AFFIDAVIT OF ASSESSMENT WORK. 2. Idaho

Transcription

1 For Bureau of Land Management Use EXAMPLE AFFIDAVIT OF ASSESSMENT WK Proof of Labor (Affidavit of Assessment is due by 30th Dec) 1. The county in which the claim is located 2. Idaho 3. One or more of the claimants names The undersigned certifies that at least one hundred ($100) dollars per claim was expended for development, labor and improvements for each mining claim listed on the reverse of this document. The mining claims are situated in, the County of, State of. Such expenditure was made by, for, or at the expense of Important Notes!, th e owner(s) of said claims, for the purpose of developing Affidavits of assessment are required for the current assessment year by Dec 30 if you: 1. filed a small miner s waiver during the previous year. 4. Current Year State of County of ) Signature0. : 2. a are switching from m s all mi ner s waiver (filed Address: the prev ious year) to the m aintenance fee for the upcoming assessment year.. 3. purchase a claim held by a small miner s waiver (filed the previous year) Subscribed and you and are sworn paying to the (or affirmed) bef ore me maintenance fee for the upcoming assessment year. this day of, 20. Failure to file an affidavit for above listed situations will cause your claims to be declared abandoned by operation of law. **If the purchase of additional claims held under a small miner s waiver causes you to exceed the 10 claim lim it you no longer qualify for a waiver and Notary Public must pay the maintenanc or Coue ntyee f Recorder that was waived for the (My commission exp newly ires ) acquired claims by the Sept 1 immediately following the purchase in addition to the maintenance fees for the upcoming year. Pursuant to 43 U.S.C and 18 U.S.C. Section 1001, the filing or recording of a false, fict itious, or fraudulent document with the Bureau of Land Management may result in a fine of up to $250,000, a prison term not to exceed five years, or both. This in formation is being collected to enable BLM to determine which claims their owner(s) wish to continue to hold under applicable Federal statute. A response is required to obtain a benefit i n accordance with Section 314 of the Federal Land and 40

2 EXAMPLE AFFIDAVIT OF ASSESSMENT WK Bureau of Land Management Use 5. Do not sign or date this unless you are in front of a notary public. Once the notary has obtained a sworn statement then you sign The undersigned certifies that at least one your hundred name. ($100) dollars per claim was expended for development, labor and improvements for each mining claim listed on the This reverse should of be this done document. at the The mining claims are situated in, the County of, State of county. however the BLM can also notarize the form Such expenditure was made by, for, or at the expense of, the owner(s) of said claims, for the purpose of developing Signature: Address: Address: State of Subscribed and sworn to (or affirmed) before me County of ) this day of, 20. Notary Public or County Recorder (My commission expires ) Pursuant to 43 U.S.C and 18 U.S.C. Section 1001, the filing or recording of a false, fictitious, or fraudulent document with the Bureau of Land Management may result in a fine of up to $250,000, a prison term not to exceed five years, or both. This information is being collected to enable BLM to determine which claims their owner(s) wish to continue to hold under applicable Federal statute. A response is required to obtain a benefit in accordance with Section 314 of the Federal Land and 42 U.S.C IMPTANT NOTICE: The information may be submitted in this format or its local equivalent. Use of this format is suggested but not required. It is not copyrighted and may be reproduced without restriction. Because applicable state laws determine certain requirements, check with your local State and Federal agencies to ensure that all requirements are met. 41

3 IMC No. CLAIM NAME IMC No. CLAIM NAME IMC Number and Claim Name You must enclose 48. a method of payment when filing a Proof of 49. Labor (POL). Cost 49. is $10 per 50. claim. If you fail 50. to include a method of payment with your POL this may result in your claim If you are filing for more than 50 claim becoming s, please abandoned attach a separate and void. document listing the other claims. Processing Fee (s) to be enclosed: claim(s) x $10.00 = $ 42

4 EXAMPLE AFFIDAVIT OF ASSESSMENT WK For Bureau of Land Management Use The un dersigned certifies that at least one hundred ( $100) dollars per clai m 8. was You expended must file for development, with the county labor and improvements for eac h 9. mining The last claim step listed is to file on with the reverse the of this document. in The which mining your claims are is located situated in, the County of, BLM State Office State located of. in Boise within 60 days after the end of the on or before Dec 30th assessment year which runs 1 Sept 1 Sept. Such expenditure was made by, for, or at the expense of, the owner(s) of said claims, for the purpose of developing Signature: Address: Address: State of County of ) Subscribed and sworn to (or affirmed) before me this day of, 20. Notary Public or County Recorder (My commission expires ) Pursuant to 43 U.S.C and 18 U.S.C. Section 1001, the filing or recording of a false, fictitious, or fraudulent document with the Bureau of Land Management may result in a fine of up to $250,000, a prison term not to exceed five years, or both. This information is being collected to enable BLM to determine which claims their owner(s) wish to continue to hold under applicable Federal statute. A response is required to obtain a benefit in accordance with Section 314 of the Federal Land and 42 U.S.C

5 EXAMPLE AFFIDAVIT OF ASSESSMENT WK For Bureau of Land Management Use The undersigned certifies that at least one hundred ($100) dollars per claim was expended for development, labor and improvements for each mining claim listed on the reverse of this document. The mining claims are situated in, the County of, State of. Such expenditure was made by, for, or at the expense of, the owner(s) of said claims, for the purpose of developing Signature: Address: State of Subscribed and sworn to (or affirmed) before me County of ) this day of, 20. Notary Public or County Recorder (My commission expires ) Pursuant to 43 U.S.C and 18 U.S.C. Section 1001, the filing or recording of a false, fictitious, or fraudulent document with the Bureau of Land Management may result in a fine of up to $250,000, a prison term not to exceed five years, or both. This information is being collected to enable BLM to determine which claims their owner(s) wish to continue to hold under applicable Federal statute. A response is required to obtain a benefit in accordance with Section 314 of the Federal Land and 42 U.S.C IMPTANT NOTICE: The information may be submitted in this format or its local equivalent. Use of this format is suggested but not required. It is not copyrighted and may be reproduced without restriction. Because applicable state laws determine certain requirements, check with your local State and Federal agencies to ensure that all requirements are met. 44

6 IMC No. CLAIM NAME IMC No. CLAIM NAME If you are filing for more than 50 claims, please attach a separate document listing the other claims. Processing Fee (s) to be enclosed: claim(s) x $10.00 = $ 45