Mining Claim Form

Arizona Department of Mines and Mineral Resources
Mining Claim Forms

Cover Information

1502 West Washington, Phoenix, AZ 85007 Phone 602-771-1600

1-800-446-4259 in Arizona FAX 602-771-1616 www.mines.az.gov

Circular No. 115 revised July 2009

MCF100 Location Notice for Lode Mining Claim

MCF102 Location Notice for Placer Mining Claim

MCF100a Claim Map

MCF108 Affidavit of Performance of Annual Work

MCF110 Notice of Intent to Hold Mining Claims/Sites

MCF112 Maintenance Fee Payment

MCF114 Supplemental Attachment (for additional claims)

MCF116 Notice of Non-liability for Labor and Materials Furnished

LOCATION NOTICE FOR LODE MINING CLAIM

MINING CLAIM MAP

Lode ( ) Placer ( )

1 mile

Scale: 1" = 2000 feet

1. The above map depicts the mining claim, which is located in Section(s) , Township , Range , Gila and Salt River Base and Meridian, County, Arizona.

2. The type of corner and location monuments used are as follows:

3. The bearings and distances in degrees and feet between claim corners are as depicted on the map.

LOCATION NOTICE FOR PLACER MINING CLAIM

AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK

When Recorded Return Document to:

Check here if this is a change of address.

Telephone:

E-mail address:

AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK – PAGE 2

6. Dates starting at 12 o'clock noon on September 1, 20 and ending at 12 o'clock noon on September 1, 20 , at least $ worth of work and improvements were done and performed.

7. Persons employed to perform the work and improvements described herein:

8. Work and improvements performed were:

9. Dated: Signature:

Subscribed and sworn to before me, a Notary Public, this day of 20

By:

Notary Public

My Commission Expires

NOTICE OF INTENTION TO HOLD MINING CLAIMS/SITES

When Recorded Return Document to:

Check here if this is a change of address.

Telephone:

E-mail Address

I (We) intend to hold the claims(s) and/or site(s) listed below for the calendar year .

Reason for filing a Notice of Intent to Hold instead of an assessment work filing (check one):

Maintenance fee was paid.

Mill or tunnel sites.

Claim(s) was located during the current assessment year.

BLM has deferred assessment work.

Claim list table: AMC number, claim/site name, county recorder data, TWP, RNG, SEC.

NOTICE OF INTENTION TO HOLD MINING CLAIMS/SITES – PAGE 2

No. of Claims: x $10 =

MAINTENANCE FEE PAYMENT

Claimant Name:

Address:

City: State: Zip:

Telephone:

E-mail address:

Signature:

Check here if this is a change of address.

List of claims:

No. of Claims: x $140 =

SUPPLEMENTAL ATTACHMENT

May be used with the following forms for listing additional mining claims:

Affidavit of Performance of Annual Work

Maintenance Fee Payment

Notice of Intent to Hold Mining Claims

Notice of Non-Liability for Labor and Materials Furnished

Additional claims table

NOTICE OF NON-LIABILITY FOR LABOR AND MATERIALS FURNISHED

NOTICE IS HEREBY GIVEN that the undersigned is the owner of the following described mine or unpatented mining claims situated in County, Arizona.

Claims table: AMC number, claim/site name, county recorder data, TWP, RNG, SEC.

Pursuant to the terms of a agreement entered into between the owner and , dated and ending on , the property will be in the possession of and operated by

DATED AND POSTED on the ground this day of , 20 .

OWNER

Subscribed and sworn to before me, a Notary Public, this day of 20

By:

Notary Public

My Commission Expires