m^:^s^a^^mm^m^. :.&m ,-^-u€¦ · Copper Assays W.O.tf 891419 cert.tf 24976 Total. 2.00 00 00....
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IRASSAY LABORATORIES LTD.-' V"*CHART¥lfcD CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS , ; , *;>>v.
^ " >86x604,-S Industrial Dr., Kirkland Lake , i'•:• ^ \: ;̂ ('t>< ^> *'''"J|| Ontario, Canada P2N 3J5 . - x |**« ,r', :"':"*"lP •'••. v. •'••••'• ' •'•'•"-"' — L ----
TEL.: (706) 667-6343
Cdaty Bumbu
m^:^s^a^^mm^m^. :.&m ,-^-u '-•••,TERMS.net 30. days, ;^. 0% ' ^V '-fl&"fe^^^
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RASSAY LA&ORATORIES LTD.D CHEMISTS, ASSAYERS, ANALYTICAUGONSUUTA^TS
Box$04, 3 Industrial Dr., KirUantf Lake - ' :' Ontario, Canada P2NlJ£ : \ .•
\URASSAY LABORATORIES LTD.
CHEMISTS, ASSAYERS, ANALYTiCAL CONSULTANTS•ial Dr., KirWand Lake ' :' •
P2N 3J5..• . .
•
TEL.: (706) 567-6343 - FAX: (705) 668-8368
BumbiJ :lRie3eew
, Thun'der Bay, Pr»tafAo'..... 1 - ,
^W^^W^V^^^^^
LABORATORIES LTD.
Bucnbu '.,;.; 2816 Ridgeway A yBhue'Ea*
TERMS . ' - .' :• ' ' ...',.-. 'net 30 days, 12.
.': *^ ^:^^'-'; ;V. ^- l
-<3:6l'cO BatoDlCopper,
:£to»»Sfrv >»4,V.* ':M% t-"" . K^'-j,*mn*!*.-,.," '*•' r.i'i-*>*i^ —' '
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ICCJJRASSAY LABORATORIES _,D CHEMISTS, ASSAYERS, ANALYTICAL CONSUUTANtSox 604, 3 Industrial Or., Kirklahd Lakff'
Ontario, Canada P2N 3J5
r t706) 667,6343 ^ FAX? (706) 508-8§68''' ' "f Buffibu ,
2816 Ridgeway Avenue •Thunder Bay/ Onfcario P7E-5K3 ' •-..•!• >
TERMS, 30.'•>': ••'' •• • ''• >«: .,"---.;.*^S;:'''''L:*i'-4r'i^fyj3'*
.l?P*ft sp^lPtp^W^^ -' ^\.. >;^ •i/i-w\& *^&;fet'f«wti-."./>-*i?K.^i C.t5*,'fc /. ; • ;' ;'t; -: Xt
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«W5fiURASSAV LABORATORIES LTD.CHA^TB«0 CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
604, 3 Industrial Dr., KWcland '.Ontario, Caneida . R2N 3J5-
|EL: (706) SB7-6343 - FAX; (705).-','* " " • ' . • j "..".
Costy Bumfcu
:i Bay^
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TO
AQCURASSAY LABORATORIES LTD.CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
, Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
TEL.: (705) 667-6343 - FAX: (705) 568-8368
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
TERMS net 30 days, 2.0% per month on overdue accounts.
April 21, 1989
Gold AssaysSample Prep. cert.#24434Silver Analysis cert.#24447
Total
7.503.501.50
731
12
505050
50
LF-1297
BELL-WHITE ANALYTICAL LABORATORIES LTD.P.O. Box 187, 374 Browning St., Halleybury, Ontario
(705)672-3107POJ1KO
SOLD TO:
Coety Bumbu 2816 Ridgeway E. Thunder Bay, Ontario P7E 5K3
SHIP TO:
Same
INVOICE
NO 34037
DATE: 0 4-14-89
PAGE 1 of 1
8.5002.0001.0002.500Sample Preparation
COMMENTS:
Net 30 Days
ACCURASSAY LABORATORIES LTD.CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
' • Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5 # 790127
TEL.: (705) 567-6343 - FAX: (705) 568-8368ro .Costy Bumbu2816 Ridgeway Avenue East Thunder Bay, OntarioDTT? G.V "3
• •
r °ATE April 25, 1989CUSTOMER ORDER N°
WORK ORDER N» T890093
DATE SUBMITTED
net 30 days, 2.0% per month on overdue accounts.
2321
Gold assaysSample Prep. cert. #24451Silver, Nickel Analyses cert. #24448Copper Analysis
Total. .................
V \-— U^j**f*r*mm ~~
S^ J V I) ^\«/O f*J~ "O**&
7.503.503.001.50
1510
61
33
00500050
00
LF-1297
ACCURASSAY LABORATORIES LTD.CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
' , Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5 # 790130
TEL.: (705) 567-6343 - FAX: (705) 568-8368
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
DATE April 28, 1989CUSTOMER ORDER N°
WORK ORDER N°T890100
DATE SUBMITTED
TERMSnet 30 days, 2.0% per month on overdue accounts.
Gold AssaysSample Prep. cert.# 24464Copper,Zinc analysesNickel analyses cert.# 24467
Total
7.503.503.001.50
31 1'i;
6'
00500050
00
LF-1297
^cui
ACCURASSAY LABORATORIES LTD.1 , CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake rio, Canada P2N 3J5 790130
TEL.: (705) 567-6343 - FAX: (705) 568-8368TO .
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
• •
DATE April 28, 1989CUSTOMER ORDER N°
WORK ORDER N» T890100
DATE SUBMITTED
>. ^
TERMS n e £ 20 days, 2.0% per month on overdue accounts.
4445
Gold AssaysSample Prep. cert. 8 24464Copper, Zinc analysesNickel analyses cert.# 24467
Total. .................
fl.L'^ 4^H^ ji^1fir •'**£+
***^s
;
3f
• /I V>***<N
+*^/(J/?\ \Jbfy'
7,503.503.001.50
301412
7
63
00000050
50
LF-1297
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ACCURASSAY LABORATORIES LTD.'. CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake rio, Canada P2N 3J5 790141
TOTEL.: (705) 567-6343 - FAX: (705) 668-8368
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
DATE May IB, 1989
CUSTOMER ORDER N°
WORK ORDER N° 8 91276
DATE SUBMITTED
TERMS net 30 days, 2.0% per month on overdue accounts.
Gold AssaysGold, Platinum, Palladium AssaysSample Prep. cert.fl 24493
Total
e^ff ac,a
7.5012.00
3.50
00
LF-1297
' ACCURASSAY LABORATORIES LTD._, 'CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5 tt 790147
TEL.: (705) 567-6343 - FAX: (705) 568-8368
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
OATE May 24, 1989CUSTOMER ORDER N°
WORKORDERN'
DATE SUBMITTED
TERMS net 30 days, 2.0% per month on overdue accounts.
Silver analysis cert.# 24501
Total
1.50 1 50
50
LF-1297
<ycut
ACCURASSAY LABORATORIES LTD.. CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
»*. * Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
*
2) D ©890738
TO .TEL.: (705) 567-6343 - FAX: (705) 568-8368 DATE
Mr. Costy Bumbu 2816 Ridgeway Avenue East Thunder Bay, Ontario P7E 5K3
TERMS
May 30, 1989CUSTOMER ORDER N°
WORK ORDER N°
VariousDATE SUBMITTED
net 30 days, 2.0% per month on overdue accounts.
6 Gold Assays W.O. #8913786 Sample Prep, cert.tt 246961 Gold Assays W.O. #8913791 Sample Prep, cert.tt 24700
Total
7.503.957.503.95
4523
80
00705095
15
LM297
tsnawK <y<w,i
_fRASSAY LABORATORIES LTD.CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
TEL.: (705) 567-6343 - FAX: (705) 568-8368
Mr. Costy Bumbu 2816 Ridgeway Avenue East Thunder Bay, Ontario P7E 5K3
890761
DATE
June 1, 1989CUSTOMER ORDER N°
WORK ORDER N°Various
DATE SUBMITTED
TERMSnet 30 days, 2.0% per month on overdue accounts.
331
Copper Analysis W.O.tf 891378 cert.tf 24761 Copper, Nickel & Zinc Analysis Silver & Copper Analysis W.O.tf 891379
Cert.tt 24772
Total
1.504.503.00
13
21
505000
00
UF-1297
ACCURASSAY LABORATORIES LTD./CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS • - 4Box 604, 3 Industrial Dr,, Kirkland Lake
Ontario, Canada P2N 3J5
•--^ f Y;
^"V I 1 ::
890762
TO .TEL.: (705) 567-6343 - FAX: (705) 568-8368 "DATE
Mr. Costy Bumbu 2816 Ridgeway Avenue East Thunder Bay, Ontario P7E 5K3
June 2, 1989CUSTOMER ORDER N°
WORK ORDER N°891419
DATE SUBMITTED
TERMSnet 30 days, 2.0% per month on overdue accounts.
55
Gold Assays W.O. * 891419 Sample Prep. cert.tt 24793
Total 57
75
25
LF-1297
&URASSAY LABORATORIES LTD.5.CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
TEL.: (706) 567-6343 - FAX: (705) 568-8368'•
f :Mr. Costy Bumbu .,: .2616 Ridgevray Avenue East 1 Thunder Bay, Ontario
P7E 5K3. » •'
»"» . i" :-
TERMS
w*;^ : i.^«^:/^i|!A^:v.-;;f|•IS-:' ,.v. •i/v^i-te-^fcXi^iJf.&as:,,-. • V... 1 .1 .•:€^lta».ii*jg',v:a'fe-:/: .;i •;.
net 30 days', 2.0% per ro^nth.
091419 ;\;.'- 1 ' ».^ . .'*|; J-'p^'.<> ̂
|-: :ft'r!l: ;
i§-
. ., -. - .^KSi'*.' -. .-'--i-.-'.J."I'^M-"-- '*&• si's? *••?**".;'-:$•*-fc?lpI^
1 •*,"',."i*J»«''">- "^ ' '"-'' v "'tl
;^l|p! l!l%iip!.:.i?;-v.4- */;; ^j:.».'{." •«".- "Q 1 •"', %1 *r".^.^ ' ' ''•'•?:•• ' -'•''•''
-; ' ;:\ vV •''.->. ^ •^i1':^^: ''^/-.-v^fej^ r/^.-^^''^"3fS^'* . '. • . . .. • .. •'v 1 3*^->-^--^ ^'^!ft; .i:p^"^; j v\:^^
"• - • ".. \ , •,..:•.. iW'-T'c * '* s-\ ', •- --W' -"* ?--J #**? *• »'^ •".;*! f. : '-V'- •''i. '•','• ,:•-' ..^i* .'^-4-; ' ,^|fii^|S;.fi*5WSir?4
.••,: ••*'•'•''•'•. ' "':-'^'r-'. ••'•'"" ^'^" :?^a'Pli' ̂ ^? ! J»(f^
. ^T^i^^^^^^^^lJI^;^1^^^
S i1 " '"'^W^' •!•W^ffi*;---',;
^' : !i;|fl
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*'•>-'••. '" '-: 'v nl'•-.^M
$&;'- v' :^i•£>,V,?» '•;',!^-^:i.
SSi,, - .'
•",^V : :..
ACCURASSAY LABORATORIES LTD.A CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake rio, Canada P2N 3J5
II Ml VCQ) 0 €5
TO
890835
TEL.: (705) 567-6343 - FAX: (705) 568-8368
Mr. Costy Bumbu 2816 Ridgeway Avenue East Thunder Bay, Ontario P7E 5K3
TERMS
DATEJune 16, 1989
CUSTOMER ORDER N°
WORK ORDER N°Various
DATE SUBMITTED
net 30 days, 2.0% per month on overdue accounts.
Copper Assays W.O.tf 891419 cert.tf 24976
Total.
2.00 00
00
AOqtlRASSAY LABORATORIES LTD.CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
I 790224
TOTEL.: (705) 567-6343 - FAX: (705) 568-8368
Costy Btmbu2816 Rldgevay Avenue BastThunder Bay, OntarioP7E-5K3
DATEJuly 5, 1989
CUSTOMER ORDER N°
WORK ORDER N°T890165
DATE SUBMITTED
TERMSnet 30 days, 2.0% per Month on overdue accounts.
3321
Gold AssaysSample Prep. cert. I 28641 Silver Analyses cert. I 28646 Silver, Copper Analysis
Amount due by August 05, 1989...$41.85
After August 20, 1989 ...........$42.69
Total,
7.503.952.003.50
221143
50850050
41 85
LF-1297
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JURASSAY LABORATORIES LTD.CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
' Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5 I 790234
TEL.: (705) 567-6343 - FAX: (705) 568-8368TO .
Costy Bumbu2816 Ridge way Avenue Bast Thunder Bay, OntarioP7E-5K3
• *
DATE July 12, 1589CUSTOMER ORDER N°
WORK ORDER N» T890176
DATE SUBMITTED
TERMS net 30 days, 2.0% per month on overdue accounts.B^-lgMgllJlRi*^^
1
1
1
Oold Assays cert. 1 28682Silver, Copper, Nickel AnalysisSample Prep. cert. 1 28675
•
Amount due by, August 12, 1989..... $l«
After August 27, 1989. ......... ...I
Total.. ..............
I/'
16
.45
.78
•
7.505.003.95
*itf *
1C
500095
1 45w ^r
i.F-1297
_ __IURASSAYisJtt^iBwfyiP CHEMISTS, A:
«|;^--,^BOX.W;Wss^aF-iiv-'^dLf'
''- •
li'S;^ /- Tirana* jc pay,^•'•^'- '$i&&& v ' : '|j&,l^.>-'-".i*r fJV-W«,J.,,, ':'•-•• . •..,:' -j.C- , i": • >;. / .If, %j^^•^•-•^v-v.'-rvo:.^^^tVu-->.'-••••• ;!',^' ;•.,,,!''•-•••'•' "• •-..••<• :';•-•. •<••;.;*•.>"';:-."'-<Si*,*,- ; u .,,'.'.," •.-TBBMSii-.-'iii.'.-An; •A.ii.-'BW'S'^' -W»->i,£i3,p^a»^fil^^i
KS1 -'*.aa*
pp^^Kvi;fvr'M;
life
?i*:'«i *3
*&
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*-34»J
•: • \.; .*v •• .; •;•..•;^r:^;- .i^i-; , •: • "i
iW'Wiil?*'«*lHfrw; .KK^i'^Wf^-w^'WI^SlftfFSi*fc8i(••S^';- A ;'''-V^-'?''??'; i:Sf'flf:\ :il v r: v;.'-V''' i;-'^" ;; -'-v';j
Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
I 790267
TOTEL.: (705) 567-6343 - FAX: (705) 568-8368
Costy Bumbu2816 Ridgevay Avenue EastThunder Bay, OntarioP7E-5K3
'DATEJuly 28, 1989
CUSTOMER ORDER N°
WORK ORDER N°T890202
DATE SUBMITTED
TERMSnet 30 days, 2.0% per month on overdue accounts.
1
1
1
Gold AssaysSample Prep. cert.l 28742Silver, Nickel, Zinc Analysis cert. I 28752
Amount due by August 27, 1989
After September 11, 1989 pay.
7.503.955.00
16
16
509500
45
78
LF-1297
<JnawK
,ACCURASSAY LABORATORIES LTD.„ CHARTiREB CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake ^^ Ontario, Canada P2N 3J5
I 790385
TEL: (705) 567-6343 - FAX: (705) 568-8368 'DATE ,-,«.-, ^ro . . September 14, 1989CUSTOMER ORDER N°
Costy Bumbu2816 Ridge way Avenue East WORK ORDER N°Thunder Bay, Ontario T890313f / H» DI\J DATE SUBMITTED
* •
TERMSnet 30 days, 2.0% per month on overdue accounts.
666
Gold AssaysSample Prep. cert.* 29018Copper Analyses cert. I 29063
Amount due before October 14, 1989. .........Please note: Accounts more than 45 days past dt
will lose any price discounts
A ,W" ^- \T
\W\
7.503.952.00
e
452312
80
007000
70
LF-1297
ACCURASSAY LABORATORIES LTD.i" 'CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake ' Ontario, Canada P2N 3J5
TO
w (())[. cc;• 790421
TEL.: (705) 667-6343 - FAX: (705) 668-8368
Goaty Buabu2816 Rldgevay Avenue EastThunder Bay, OntarioP7E-5K3
DATE September 26, 1969CUSTOMER ORDER N°
WORK ORDER N° T890338DATE SUBMITTED
TERMS net 30 days, 2.0% per Month on overdue accounts.
Gold Assay Sample Prep. Copper Analysis
W.O. IT890338 cert.I 29081 cert.» 29189
Amount due before October 26, 1989
Please note: Accounts more than 45 days past < will lose any price discounts
7.503.952.00
uei;
509500
45
LF-1297
. ACCURASSAY LABORATORIES LTD.•CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
' • 'Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
TOTEL.: (705) 567-6343 - FAX: (705) 668-8368
Costy Bumbu2816 Ridgeway Avenue BastThunder Bay, OntarioP7E-5K3
I 790446
DATE September 29, 1989CUSTOMER ORDER N°
WORK ORDER N° T890389DATE SUBMITTED
TERMS net 30 days, 2.0% per month on overdue accounts.
333
Gold AssaysSample Prep.Silver, Copper Analyses
cert.i 29211 cert.I 29230
Amount due before October 29, 1989
Please note: Accounts more than 45 days past d will lose any price discounts
7.503.953.50
,.
221110
44
508550
85
LF-1297
AC€URASSAY LABORATORIES LTD.'CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
-•' 'Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
I 790448
TEL.: (705) 567-6343 - FAX: (705) 568-8368 TO . .
Costy Bumbu2816 Ridgevay Avenue EastThunder Bay, OntarioD*71?— RV ^ r I d 3 l*iO
•
°ATE October 5, 1989CUSTOMER ORDER N°
WORK ORDER N°T890414
DATE SUBMITTED
net 30 days, 2.0% per month on overdue accounts.
22
Gold AssaysSample Prep. cert. ft
i^jM^^^^^^^mHBHi29264
'jlSfS^SSi^K^^^liif^^^^t^^^i^^^K
Please note: Accounts more than 45 days past dvwill lose any price discounts
0 'kty 'Y(\P^ u1 /j-2^
J&'\ j
v++-
7.503.95
e
157
22
0090
90
LF-1297
t^out
^CCURASSAY LABORATORIES LTD./CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS
Box 604, 3 Industrial Dr., Kirkland Lake Ontario, Canada P2N 3J5
* 790503
TOTEL.: (705) 567-6343 - FAX: (705) 568-8368
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
TERMSnet 30 days, 2.0% per month
DATE October 25, 1989CUSTOMER ORDER N°
WORK ORDER N° T890466DATE SUBMITTED
overdue accounts,
332
Gold Assays Sample Prep. Copper Analyses
cert.# 31017 cert.# 31031
Amount due before November 24, 1989.
Please note: Accounts more than 45 days past die will lose any price discounts
7.503.952.00
2211
4
38
508500
35
LF-1297
, ACCyRASSAY LABORATORIES LTD., 'CHARTERED CHEMISTS, ASSAYERS, ANALYTICAL CONSULTANTS'' 'Box 604, 3 Industrial Dr., Kirkland Lake
Ontario, Canada P2N 3J5I 790529
TOTEL.: (705) 567-6343 - FAX: (705) 568-8368
Costy Bumbu2816 Ridgeway Avenue EastThunder Bay, OntarioP7E-5K3
DATENovember 1, 1989
CUSTOMER ORDER N°
WORK ORDER N °T890496
DATE SUBMITTED
TERMSnet 30 days, 2.0% per month on overdue accounts.
2211
Gold AssaysSample Prep.Silver, Nickel, Zinc AnalysisSilver Analysis
cert. I 31090 cert. I 31126
Amount due before December 1, 1989
Please note: Accounts more than 45 days past d will lose any price discounts
lie
7.503.955.002.00
15752
29
00900000
90
LF-1297
Ministry ofNorthern Developmentand Mines
DOCUMENT N
OntarioReport of Work
,ng Act (Expenditures, Subsection 77(19)) /j/f»f2.13863 HAY LAKE 900
Type of Work Performed Mining Division Township or Area
Recorded Holder 'Prospector's Licence No.
Address TelephoraNo.62Z-/2?/
Work Performed^
Name and Address of ALrthor (of Submission} Date When Work was PerformedW./-../W* /^Pay I Mo. I Yr. I Pay I Mo. | tf.
I All the work was performed on Mining Claim(s): I Indicate no. of days performed on each claim. I 'See Note No. 1 on reverse side________
Mining Claim No. of Days Mining Culm No. of Daya Mining Culm No, of Days Mining Ctolm No. of Days
I Mining Claim No. of Days Mining Claim .No. of Days Mining Claim No. of Days Mining Claim No. ofOayt Mining Claim NaofOayt Mining Claim No. of Oayt
,M«iing Claim No. of Oayi Mining Claim Mining Claim No. of Dayt Mjjnlng Claim No. of Days Mining Claim No. of Day* Mining Claim No. of Dayi
'' Instruction* ' Total days credits may be distributed at claim j holder's choice. Enter number of days credits per j claim In the expenditure days credit column
(below)._____________________
Calculation of Expenditure Days Credits Total Expenditures ^*
Total Number of Mining Claims Covered by this Report of Work
Mining Claims (List In numerical sequence). If space Is Insufficient, attach schedules with required InformationMining Claim
Prefix NumberExpend. Days Cr.
Mining ClaimPrefix Number
Expend. Days Cr.
Mining ClaimPrefix Number
Expend. DaysCr.
Mining ClaimPrefifi Number
Expend. DaysCr.
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R i-l C E \ V ETotal Number of Days Performed Total Number of Days Claimed r of Days to be Claimed at a Future Date
Certification of Beneficial Interest 'See Note No. 2 on reverse side1 hereby certify that, at the time the work was performed, the claims covered In this report of work were recorded in the current recorded holder's name or held under a beneficial interest by the current recorded holder.
Uate,
. Jt/90Recorded rfolder or Agent (Signature)
Certification Verifying Report o( Work1 hereby certify that 1 have a personal and Intimate knowledge of the facts set forth In the Report of Work annexed hereto, having performed the work or witnessed same during and/or after Us completion and the anpexed report Is true.Name and Address of Person Certifying /
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For Office Use Onlyi Total Days j Cr. Recorded
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Dale Recorded
Date Approved as Recorded
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