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NOTICE!!
These documents have been scanned!
Do not place un-scanned documents beneath this notice!
Do not remove this notice from this file!
GPO Jacket No. 560-102 Print Order 61540
Rise Business Services, LLC Job=AZ15 5 /1 0 /2 0 1 9
Box Number= AZ15031
Claim Begin-End: AMC429662-AMC429663
1 Initial Receipt
AZ15031-20 AMC429540-AMC429995
AZ15031
AMC429662-AMC429663
BREAK
AMC# DATE CLOSED REMARKS
y ( ^ ° i (o fa
i........... ........................................................... ..... ...............................................................
f-------------------------------------
, ____________________________________ l
.. ....... — ........- * 1 ' ....... ................1 . . . . -------------------------------------------------------------------------------------- -
_______________________________ __ !..... — ---------------------------------------------------------------- - ......... ............................1
Page 1 of 2
United States Department of thè InteriorBureau of Land Management Receipt
LANDS/RECREATION & PLANNING ONE N CENTRAL AVE
PHOENIX, AZ 85004 -2203 • Ny: 3164646Phone: 602-417-9200
Transaction #: 3257271 Date of Transaction: 11/07/2014
pIlusS -
■ V 1 ’ J
CUSTOMER:RICHARD S LAUGHLINPO BOX 111MORRISTOWN,AZ 85342-0111 US
LINE# QTY DESCRIPTION REMARKS
UNITPRICE TOTAL
1 2.00LOCATABLE MINERALS / MINING CLAIMS- NEW,UNADJUD, ONE OR MORE AUTH NOS / NEW MINING CLAIMS LOCATION FEE CASES: AMC429662/$37.00, AMC429663/$37.00
- n/a - 74.00
2 2.00LOCATABLE MINERALS / MINING CLAIMS- NEW,UNADJUD, ONE OR MORE AUTH NOS / NEW MINING CLAIM PROCESSING FEE CASES: AMC429662/$20.00, AMC429663/$20.00
- n/a - 40.00
3 2.00LOCATABLE MINERALS / MINING CLAIMS- NEW,UNADJUD, ONE OR MORE AUTH NOS / NEW MINING CLAIMS MAINTENANCE FEE CASES: AMC429662/$ 155.00, AMC429663/$155.00
- n/a - 310.00
TOTAL: $424.00
PAYMENT INFORMATION1 AMOUNT: 212.00 POSTMARKED: N/A
TYPE: CHECK RECEIVED: 11/06/2014CHECK NO: 1122
NAME: LAUGHLIN, RICHARD S 3296 HARDEE AVE CHAMBLEE AZ 30341 US
2 AMOUNT: 212.00 POSTMARKED: N/ATYPE: CHECK RECEIVED: 11/06/2014
CHECK NO: 1125NAME: LAUGHLIN, RICHARD S
3296 HARDEE AVE CHAMBLEE AZ 30341 US
11/7/14
Page 2 of 2
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
11/7/14
NOTICE!!
These documents have been scanned!
Do not place un-scanned documents beneath this notice!
Do not remove this notice from this file!
GPO Jacket No. 560-102 Print Order 61540
Rise Business Services, LLC Job=AZ15 5 /1 0 /2 0 1 9
Box Number= AZ15031
Claim Begin-End: AMC429662-AMC429663
2 Correspondence
AZ15031-20 AMC429540-AMC429995
AZ15031
AMC429662-AMC429663
BREAK
SJ)
1 States Department ôf ï Interioî*BUREAU OF lJ nD MANAGEMENT
Arizona State Office One North Central Avenue, Suite 800
Phoenix, Arizona 85004-4427 www.blm.gov/az/
■A '■ /.ÜiC
In Reply Refer To:3830 (9200) PB AMC429662
CERTIFIED MAIL - RETURN RECEIPT REQUESTED No. 9214 8901 9403 8376 3565 74
DECISION
TOMMIE WHEELER : This decision affects those claims3320 E UNIVERSITY DR : shown in the block below.MESA, AZ 85213-8670 :
AMC429663AGPC-9
MINING CLAIMS DECLARED FORFEITED
The mining claims listed above have been declared forfeited as of September 1,2018, for failure to timely file the required maintenance fee payment or small miner’s maintenance fee waiver (waiver).
Claimants are required to pay an annual non-refundable maintenance fee of SI 55 per 20 acres or portion thereof, or submit a waiver, on or before September 1 of each year. These requirements were established by 30 U.S.C. 28f-l, as amended, and 43 CFR 3834 and 3835.
Our records do not show receipt of a maintenance fee payment or small miner waiver filed on or before the due date. Therefore, the claims listed above are forfeited.
Reclamation Requirements
This decision does not relieve you of the liability for reclamation of all areas disturbed by your activities on lands covered by the subject mining claim(s) and/or site(s). After you complete the reclamation, you must notify the authorized officer of the appropriate surface managing agency so that the authorized officer may conduct a final site inspection and determine whether you may be released from liability. If you fail to reclaim the land to the satisfaction of the authorized
officer, the surface management agency maV cite you for noncompliance under its surface management regulations. For land administered by the Bureau of Land Management (BLM), if you fail to reclaim the land to the satisfaction of the authorized officer as required in 43 CFR Subpart 3809, the BLM will issue an order of noncompliance under 43 CFR 3809.601(a). If you fail to comply with the non-compliance order, BLM may take further action under 43 CFR 3809.604. Failure to conduct reclamation is a prohibited act that may subject you to criminal penalties. See 43 CFR 3809.605(h) and 43 CFR. 3809.700.
This decision may be appealed to the Interior Board of Land Appeals, Office of the Secretary, in accordance with the regulations contained in 43 CFR, Part 4, and the enclosed Form 1842-1. If an appeal is taken, your notice of appeal must be filed in this office (at the above address) within 30 days from receipt of this decision. The appellant has the burden of showing that the decision appealed from is in error.
If you wish to file a petition pursuant to regulation 43 CFR 4.21 (58 FR 4939, January 19, 1993) tor a stay of the effectiveness of this decision during the time that your appeal is being reviewed by the Board, the petition for a stay must accompany your notice of appeal. A petition for a stay is required to show sufficient justification based on the standards listed below. Copies of the notice of appeal and petition for a stay must also be submitted to each party named in this decision and to the Interior Board of Land Appeals and to the appropriate Office of the Solicitor (see 43 CFR 4.413) at the same time the original documents are filed with this office. If you request a stay, you have the burden of proof to demonstrate that a stay should be granted.
Except as otherwise provided by law or other pertinent regulation, a petition for a stay of a decision pending appeal shall show sufficient justification based on the following standards:
( 1 ) The relative harm to the parties if the stay is granted or denied,(2) The likelihood of the appellant's success on the merits,(3) The likelihood of immediate and irreparable harm if the stay is not granted, and(4) Whether the public interest favors granting the stay.
Please include your AMC serial number(s) on all correspondence. If additional information is required, please call Pauline Brown at 602-417-9360.
Appeal Procedures
Standards for Obtaining a Stay
Lucas LuceroDeputy State DirectorLands, Minerals, and Energy Division
Enclosure
U NITED STATES POSTAL SERVICE t
DATE PRODUCED: 1/14/2019 4:21 PM
US DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT:
The following is information for Certified Mail™/RRE item number: 9214 8901 9403 8376 3565 74
Our records indicate that this item was RETURNED TO SENDER.
ORIGINAL INTENDED RECIPIENT:TOMMIE WHEELER 3320 E UNIVERSITY DR MESA AZ 85213-8670
The above information represents information provided by the United States Postal Service.
Return Reference Number:
NOTICE!!
These documents have been scanned!
Do not place un-scanned documents beneath this notice!
Do not remove this notice from this file!
GPO Jacket No. 560-102 Print Order 61540
Rise Business Services, LLC Job=AZ15 5 /1 0 /2 0 1 9
Box Number= AZ15031
Claim Begin-End: AMC429662-AMC429663
3 Transfers
AZ15031-20 AMC429540-AMC429995
AZ15031
AMC429662-AMC429663
BREAK
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OFFICIAL RECORDS OF IARICOPA COUNTY RECORDER
HELEN PURCELL2 0 1 6 0 9 0 5 9 4 5 1 2 /0 8 /2 0 1 6 0 1 :5 3
KIOSK RECORDING1 0 5 9 1 9 7 -2 -3 -1 ram irezj
QUIT CLAIM DEED
DO NOT REMOVE
This is part of the official document
RFCETIVFOCL ' ' r "■’„■! re.-
201b OEC I I I P I: 33
PhC-Lli-.'X. ARIZONA
QUIT CLAIM DEED
The undersigned grantor(s), fo r valuable consideration, receipt o f which is hereby acknowledged, in the am ount o f $10.00, o r o ther values, do we hereby remise, release and forever q u it claim to the fo llow ing described property in th ^ c o u n ty o f ,
o f _ M ining Claim known as ,stateSectionTownship 4 A / Range , \ I I /
Section(s) f jJ z jiJ fc r ,____ Claim ft
___ Address:
C ity :___ State:
32 2 Zip:
TRANSFER FEE EXEMPT PER ARS 11-1134-AÔ
OWNER
7 day o f AA êCÇtn , 20 L(rt. personally appeared before me, a NotaryOn thePublic in and fo r the above state and county,
Cshgr-ci jR A 1/n____________ _, known to me or proved to be theperson(s) named in and who executed the foregoing instrum ent, and being firs t duly sworn, such person acknowledged th a t he or she executed said instrum ent fo r the purpose therein contained as his or her free and vo luntary act and deed.
NOTARY PUBLIC
R\J BY E J CAN O £EK j Notary Public - State of Arizona !
MARICOPA COUNTY |7 / My Commission Gxoires (
•-jr.-o. SOTO !
M y Commission Expires p O ^ O
\
U nited States D epartm ent o f the Interior B ureau o f Land M anagem ent
DIV OF LANDS, MINRLS & ENERGY ONE N CENTRAL AVE
Receipt
PHOENIX, AZ 85004 -4427 Phone: 602-417-9200
No: 3723505
Transaction #: 3828673Date of Transaction: 12/15/2016___________________
CUSTOMER:IIr ic h a r d s l a u g h l inPO BOX 111MORRISTOWN,AZ 85342-0111 US____________
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMSNOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVED CASES: AMC429663/S 10.00
QCD - 1 - n/a - 10.00
T O T A L : $10.00
PAYMENT INFORMATION1 AMOUNT: 10.00 POSTMARKED: 12/09/2016
TYPE: CHECK RECEIVED: 12/14/2016CHECK NO: 137
NAME: LAUGHLIN, RICHARD STANLEY PO BOX 111MORRISTOWN AZ 85342-0111 US
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
DEC 1 \ ¿ütö
PRESS FIRMLY TO SEALPRESS FIRMLY TO SEAL
PRIORITY* K A I L *
[HT! DATE OF DELIVERY SPECIFIED*
(fr% USPS TRACKING™ INCLUDED*
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g / r^ f^U iP IC K U P AVAILABLE~»r: ccL, i j - <X * Domestic only
2 - ' - :< r - /v,: cj rzztxjQ !_U5_ =e °—; c=> 3TU. li .
W HEN USED INTERNATIONALLY,A CUSTOMS DECLARATION LABEL MAY BE REQUIRED.
F R O M : £ £ G » Z J V
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U N IT E D STATES POSTAL SERVICE*.
USPS TRACKING #
9114 9999 4431 3055 9632 42
0 03"aCl''"é8Sné
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VISIT US AT USPS.COM'ORDER FREE SUPPLIES ONLINE
UNITEDSTATES POSTAL SERVICE*
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9114999944313055963242
NOTICE!!
These documents have been scanned!
Do not place un-scanned documents beneath this notice!
Do not remove this notice from this file!
GPO Jacket No. 560-102 Print Order 61540
Rise Business Services, LLC Job=AZ15 5 /1 0 /2 0 1 9
Box Number= AZ15031
Claim Begin-End: AMC429662-AMC429663
4 Annual Filings
AZ15031-20 AMC429540-AMC429995
AZ15031
AMC429662-AMC429663
BREAK
Form 3830-2 (October 2013)
UNITED STATESDEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
MAINTENANCE FEE WAIVER CERTIFICATION
SEE INSTRUCTIONS ON PAGE 2
FORM APPROVED OMBNO. 1004-0114
Expires: October 31,2016
1 This small m iner waiver is filed for the assessm ent year beginning on Septem ber 1, 2018 and ending on Septem ber 1. 20192. The undersigned and all related parties owned ten or fewer m ining claims , mill, or tunnel sites located and maintained on Federal lands in the United States
o f Am erica on Septem ber 1, 20181 The undersigned have perform ed the assessm ent work required by law for each m ining claim listed prior to filing this waiver and understand that by filing this torm,
the undersigned m ust file an affidavit o f assessm ent work with the Bureau o f Land M anagem ent (BLM ) by the December 30th follow ing the filing o f this waiver.4. The undersigned understand that if the assessm ent work obligation has not yet come due under 30 U.S.C. 28 (for those claim s in their first assessm ent year only),
a notice o f intent to hold reciting this condition m ust be recorded by the D ecem ber 30th follow ing the filing o f this waiver.5 The undersigned understand that mill and tunnel sites m ay also be listed on this waiver and be waived from paym ent o f the m aintenance fee, and that a notice o f
intent to hold for these sites is required to be filed with the BLM by the December 30th follow ing the filing o f this waiver.6. The undersigned understand and acknow ledge that pursuant to 43 U.S.C. 1212 and 18 U .S.C. 1001, the filing or recording of a false, fictitious, or fraudulent
docum ent with the BLM m ay result in a fine o f up to $250,000, a prison term not to exceed five years, or both.7. The m ining claims, mill or tunnel sites for which this w aiver from paym ent o f the m aintenance fees is requested are:
CLAIM OR SITE NAME \ BLM RECORDATION SERIAL NUMBER ______________ /. ^ ------------------------------l. AG PC-8 AMC429662 C T l ^
2.
3.~ ~
4. —L. ••**’*•c~"* ... ------- ----------------------
5. m a»- t>_____________ ZZ-------S --------223------------------------
6.'rn
_____________ >5____^ ___ L S ______________7.
~ rn_____________ ^ ------------------------
8. r-4 ^ . o
9.C5 “ n"s" • * "n
10.J> :.•>
- J r V-)
The ow ner(s) (claim ants) o f the above m ining claim s and sites are:
RICHARD S. LAUGHLIN
(O w ner's N am e - Please Print) (O w ner'iÆ ignature)
PO BOX 111 MORRISTOWN A Z 85342
(O w ner's M ailing Address) (City) (State) (Zip Code)
(O w ner's N am e - Please Print) (O w ner's Signature)
(O w ner's M ailing Address) (City) (State) (Zip Code)
(O w ner's Nam e - Please Print) (O w ner’s Signature)
(O w ner's M ailing Address) (City) (State) (Zip Code)
1
Form *3830-2 (October 2013)
\ \ X \ ' V u ^ c ;
Lin i 'ED STATESDEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
MAINTENANCE FEE WAIVER CERTIFICATION
SEE INSTRUCTIONS ON PAGE 2
FORM APPROVED OMB NO. 1004-0114
Expires: October 31,2016
1. This small m iner waiver is filed for the assessm ent year beginning on Septem ber 1, 2018 and ending on Septem ber 1, 20192. The undersigned and all related parties owned ten or fewer m ining c la im s . m ill, or tunnel sites located and m aintained on Federal lands in the United States
o f Am erica on Septem ber 1. 2 0 1 8 __ ■3. The undersigned have perform ed the assessm ent work required by law for each m ining claim listed prior to filing this waiver and understand that by filing this form,
the undersigned m ust file an affidavit o f assessm ent w ork with the Bureau o f Land M anagem ent (BLM ) by the December 30th follow ing the filing o f this waiver.4. The undersigned understand that if the assessm ent work obligation has not yet come due under 30 U.S.C. 28 (for those claim s in their first assessm ent year only),
a notice o f intent to hold reciting this condition m ust be recorded by the December 30th follow ing the filing o t this waiver.5. The undersigned understand that mill and tunnel sites m ay also be listed on this waiver and be waived from paym ent o f the m aintenance fee, and that a notice o f
intent to hold for these sites is required to be filed with the BLM by the Decem ber 30th follow ing the filing o f this waiver.6. The undersigned understand and acknow ledge that pursuant to 43 U .S.C 1212 and 18 U.S.C. 1001. the filing or recording o f a false, fictitious, or fraudulent
docum ent with the BLM m ay result in a fine o f up to $250,000, a prison term not to exceed five years, or both.7. The m ining claims, mill or tunnel sites for which this w aiver from paym ent o f the m aintenance fees is requested are:
CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER
1 AGPC-8 AMC429662 V ' \ \
2. r3. _________________ 5 ____a jg ____________4. O S 5
5. Z Cg N 3 3
6. 1 ' J o________________ ______ JT___ T .ra ___________
7. to _ : r , <
8. U o o
9. — Z w Hi-________________> ____Q ___________________
10. OO .'Tl
The owner(s) (claim ants) o f the above m ining claim s and sites are:
RICHARD S. LAUGHLIN
(O w ner’s N am e - Please Print) (Owner'sJjTgnalure)
PO BOX 111 MORRISTOWN AZ 85342
(O w ner’s M ailing Address) (City) (State) (Zip Code)
(O w ner’s N am e - Please Print) (O w ner’s Signature)
(O w ner's M ailing Address) (City) (State) (Zip Code)
(O w ner’s N am e - Please Print) (O w ner’s Signature)
(O w ner's M ailing Address) (City) (State) (Zip Code)
(O w ner’s N am e - Please Print) (O w ner’s Signature)
(O w ner's M ailing Address) (City) (State) (Zip Code)
(Continued on page 2)
BLM
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V JO7Q17 mso DODO 444Q
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05004-442700 l ,lHìl l ì ‘U' l ‘] ' ìll " l ,ll l l l l l l l ì ' l l l ,l
70171450000083264440
Form 3830-2 (January 2017)
IITED STATES DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
MAINTENANCE FEE WAIVER CERTIFICATION
Vo k -
SEE INSTRUCTIONS ON PAGE 2
fo r m Appro v edOMB NO. 1004-0114
Expires: January 31,2020
This small m iner waiver is filed for the assessment year beginning on September l , '*/ A. 'J. it and ending on Septem ber 1, T T J7 7
The undersigned and all related parties,ow ned ten or few er mining c la im s, mill, or tunnel sites located and m aintained on Federal lands in the United States o f A m erica on September 1 -The undersigned have perform ed the assessment w ork required by law for each m ining claim listed prior to filing this waiver and understand that by filing this form, the undersigned must file an affidavit o f assessment w ork with the Bureau o f Land M anagem ent (BLM) by the December 30th following the filing o f this waiver. The undersigned understand that i f the assessment w ork obligation has not yet come due under 30 U.S.C. 28 (for those claims in their first assessm ent year only), a notice o f intent to hold reciting this condition m ust be recorded by the December 30th following the filing o f this w aiverThe undersigned understand that mill and tunnel sites may also be listed on this w aiver and be waived from paym ent o f the maintenance fee, and that a notice o f intent to hold for these sites is required to be filed w ith the BLM by the December 30th following the filing o f this waiver.The undersigned understand and acknowledge that pursuant to 43 U.S.C. 1212 and 18 U.S.C. 1001, the filing or recording o f a false, fictitious, or fraudulent docum ent with the BLM may result in a fine o f up to $250,000, a prison term not to exceed five years, or both.The m ining claims, mill or tunnel sites for which this waiv er from payment o f the m aintenance fees is requested are:
CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER
T ~ W T i P C - . T A / ' K2. ~V ss r~3. ZE 5 ®
4. L£! rn x *o
5. >< ^
6.—j> ■ --><
______________ P T ) ____________7.
8. z ” —:______________ i> & _______________
9. _ j
10. r
The owner(s) (claimants) o f the above m ining claims and sites are:
< u ) i f c - / / j j /(Owne
> 4 ^ / 7 /
(O w ner’s Nam e - Please Print)
(O w ner’s M ailing Address)
(O w ner’s Nam e - Please Print) (O w ner’s Signature)
(O w ner’s M ailing Address) (City) (State) (Zip Code)
(O w ner’s Name - Please Print) (O w ner's Signature)
(O w ner’s M ailing Address) (City) (State) (Zip Code)
(O w ner’s Name - Please Print) (O w ner’s Signature)
(O w ner’s Mailing Address) (City) (State) (Zip Code)
(Continued on page 2)
(O w ner's N am e - Please Print) (O w ner’s Signature)
(O w ner's M ailing Address) (City) (State) (Zip Code)
(O w ner's Nam e - Please Print) (O w ner's Signature)
(O w ner’s M ailing Address) (City) (State) (Zip Code)
(O w ner’s N am e - Please Print) (O w ner's Signature)
(O w ner’s M ailing Address) (City) (State) (/ ip Code)
(Otvner’s N am e - Please Print)
1 V(O w ner’s Signature)
(O w ner’s M ailing Address) (City) (State) (Zip Code)
18 U .S.C . 1001 and 43 U .S.C . 1212 m ake it a crim e for any p erson know ingly and w illfu lly to m ake to any departm ent or agency o f the U n ited States any false, fictitious o r fraudulent s ta te m e n ts o r represen tations as to any m atter w ithin its ju risd ic tion ._______
IN STR U C TIO N S1. This certification is m ade u nder the provisions o f 43 U .S .C . § 1744 and 30 U .S.C . §28-28k and the regu lations thereunder (43 CTR P art 3830).2. The cla im ant(s) m ust fill in the dates in paragraph 1 for the beg inn ing and ending o f the assessm ent year for w h ich th is w aiver is sought.3. fhe cla im ant(s) m ust fill in the date in paragraph 2 for the beg inn ing o f the assessm en t year for w hich th is w aiver is sought.4. All claim an d site nam es and B L M serial num bers m ust be listed for the m ining claim s, mill sites, and tunnel sites for w hich the w a iv e r is sought.5. All ow ners o f the m in ing claim s, m ill sites, and tunnel s ites and their addresses m u st be given.6. This w aiver form m ust be s ig n ed by all the claim ants o r th e ir designated agent, in orig inal form. I f an agent is designated , a no tarized d esignation o f
agent, signed by all o f the c la im an ts w ith proper address g iven , m ust be subm itted w ith this waiver.7. This form m u st be filed no la te r th an Septem ber 1st for the upcom ing assessm ent y ea r in the BLM State O ffice w here the m in ing c la im s o r sites are
recorded, o r the w aiver cannot be g ran ted by the BLM . (E xam ple: To obtain a w a iv e r for the assessm ent year 2012. w hich beg ins on S ep tem b er 1 .2011, you m ust qualify for and file fo r a w aiv er no later than S ep tem b er 1, 2011, in the p roper BLM State O ffice.)
8. For all m in ing claim s w hich requ ire assessm ent w ork, y o u m u st record an affidavit o f labor on or before the D ecem ber 30th im m ed ia te ly follow ing the filing o f th is w aiver. For all o th e r m in ing claim s or sites w aived , you m ust record a notice o f intent to ho ld on o r before the D ecem ber 30 th immediately fo llow ing th e filing o f this w aiver.
9. M ill and tunnel sites m ay also be listed on this w aiver and be w aived from paym en t o f the m aintenance fee. A notice o f intent to hold fo r these sites is required to be filed by the D ecem b er 30th follow ing the filing o f this waiver.
FOR OFFICIAL USE ONLY
(Continued on page 3) (Form 3830-2, page 2)
V X / •' /
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^FICIAL RECORDS OF MARICOPA COUNTY RECORDER
ADRIAN FONTES2 0 1 8 0 6 1 9 5 2 9 0 8 /1 5 /2 0 1 8 0 1 :5 9
KIOSK RECORDING
0 8 4 8 4 2 8 -3 -2 -1h e rn a n d eze
MAINTENANCE FEE WAIVER CERTIFICATION
DO NOT REMOVE
This is part o f the official document
~orr SS CJo ea —m >►z;x>
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When Recorded Return Document to: RICHARD S. LAUGHLIN
PO BOX 111____________
MORRISTOWN, A2 85342
□ Check here is this is a change of address.
Telephone: 770-630-8828_________________
E-mail address: [email protected]
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK
1. State of Arizona, County of M ARICOPA__________
2. I (Name) R ICHARD S. LAUGHLIN___________
ss:
3. Reside at (Address) PO BOX 111
C ity M O RRISTO W N County M ARICOPA
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State AZ zip 85342x r r o
__being duly sworn, depose and say that I am a citizen of the United StaTsi, mbYe thaneighteen years of age, and that all of the facts set forth in this affidavit, subject to the provisions and penalties of 18 U.S.C. 1001 pertaining to the filing of false, fictitious, or fraudulent statements with the United States, are true and correct according to the best of my knowledge, information and belief.4. Owner’s name and address (If not shown in Items 1-3 above). SEE ABOVE____________________________
5. That I am personally acquainted with the mining claim(s). The work and improvements were made by and at the expense of the owner(s) of said claim(s). Said contiguous group of claims, listed on this document, are situated in the
SAN DO M ING O______ (optional) Mining District; M ARICOPA County, Arizona.
LineNo.
AMCNUMBER CLAIM/SITE NAME COUNTY RECORDER
DATA (If available) TWP RNG SEC
1 A M C429662 AGPC-8 2014-0647443 7N 3W 30
2
3
4
5
6
Form: MCF108Revised July 2014
Page 1 o f2
. AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK - page 2
6. That between the dates starting at 12 o’clock noon on September 1, 20 17 and ending at 12 o’clock noon onSeptember 1, 2018__ at least $ 300.00__________ dollars worth of work and improvements were done and performedupon said claim(s) or upon one or more of a contiguous group of claims for the benefit of all, wholly or partly outside of a contiguous group of claims for the benefit of all, not including the location work.
7. That the following persons were employed to perform the work and improvements described herein:____________
RICHARD S. LAUGHLIN, BRETT S. LAUGHLIN
8. That the work and improvements performed were: HAND EXCAVATED SEVERAL BENCH AREAS TO TEST
THEN FILLED IN TEST TRENCHES. ALSO FILLED IN SEVERAL W ASHED O UT A R E ^S ON TH E AC CESS ROAD
REPLACED M ISSING CO R N ER MARKER
9. Dated: ignature:
SUBSCRIBED AND SWORN TO before me, a Notary Public, this
By:. C d o s i £
Notary Public__
My Commission Expires
ay of 20 ( i
Bureau of Land Management . . . . . Arizona State Office ¿ A # '',w *>lm3° v;az
2 : -mm • [¿ f KEEl ^3 ^ j o Id
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No. of Claims: x $10 =Check No.: {nit.Receipt No.: A f n 7 9 7 2 £ 5 CFor BLM Use Only
Form: MCF108Revised July 2014
Page 2 o f2
This form is available from the Arizona Geological Survey and may be reproduced.
TFICIAL RECORDS OF MARICOPA COUNTY RECORDER
ADRIAN FONTES2 0 1 8 0 6 1 9 5 3 0 0 8 /1 5 /2 0 1 8 0 1 :5 9
KIOSK RECORDING
0 8 4 8 4 2 8 -3 -2 -2h ern a n d eze
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK
DO NOT REMOVE
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Receipt Page 1 of 1
United States Department of the Interior Bureau of Land Management
DIV OF LANDS, MINRLS & ENERGY ONE N CENTRAL AVE
Receipt
PHOENIX, AZ 85004 -4427 Phone: 602-417-9200
No: 4242722
Transaction #: 4358152Date of Transaction: 08/23/2018 __________________
CUSTOMER:llRICHARD S LAUGHLIN PO BOX 111MORRISTOWN,AZ 85342-0111 US____________
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMSNOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVED CASES: AMC429662/$ 10.00
POL 2018/1 WAV - n/a - 10.00
TOTAL: $10.00
PAYMENT INFORMATION1 AMOUNT: 10.00 POSTMARKED: N/A
TYPE: CHECK RECEIVED: 08/21/2018
CHECK NO: 165NAME: LAUGHLIN, RICHARD S
PO BOX 111MORRISTOWN AZ 85342-0111 US
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
https://ilmocop0ap933.blm.doi.net/cgibin/cbsp/zorder 8/23/2018
When Recorded Return Document to: RICHARD S. LAUGHLIN
PO BOX 111____________MORRISTOWN, AZ 85342
□ Check here is this is a change of address.
Telephone: 770-630-8828________________
E-mail address: [email protected]
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK
1. State of Arizona, County of MARICOPA__________
2 . 1 (Name)
ss:
RICHARD S. LAUGHLIN
3. Reside at (Address) PO BOX 111
City MORRISTOW N County MARICOPA
BLM
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State AZ z ip 85342_______being duly sworn, depose and say that I am a citizen of the UnitectStatdy more.thaneighteen years of age, and that all of the facts set forth in this affidavit, subject to the provision^and paaaltiesof 18 U.S.C. 1001 pertaining to the filing of false, fictitious, or fraudulent statements with the United States, are true^and correct according to the best of my knowledge, information and belief.4. Owner’s name and address (If not shown in Items 1-3 above). SEE above ________________________
5. That I am personally acquainted with the mining claim(s). The work and improvements were made by and at the expense of the owner(s) of said claim(s). Said contiguous group of claims, listed on this document, are situated in the
SAN DOMINGO (optional) Mining District; MARICOPA_________________ County, Arizona.
LineNo.
AMCNUMBER CLAIM/SITE NAME COUNTY RECORDER
DATA (If available) TWP RNG SEC
1 AMC429662 AGPC-8 7N 3W 30
2
3
4
5
6
Form: MCF108Revised July 2014
Page 1 o f2
f,
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK - page 2
7. That the following persons were employed to perform the work and improvements described herein:
RICHARD S. LAUGHLIN, BRETT S. LAUGHLIN
8. That the work and improvements performed were: GENERAL PROSPECTING AND ROAD MAINTENANCE
9. Dated: / b / / ‘O Signature: <
SUBSCRIBED AND SWORN TO before me, a Notary Public, this '
By:.
Notary PublicT Ü '
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My Commission Expires
Bureau of Land Management Arizona State Officevww.blm.aov/az
No. o f Claim s: x $ J 0 ap j
Check No.: Init.
R eceipt No.: ¿ ~ j f ) <^)
For BLM Use Only
Form: MCF108Revised July 2014
Page 2 o f2This form is available from the Arizona Geological Survey and may be reproduced.
OFFICIAL RECORDS OF MARICOPA COUNTY RECORDER
ADRIAN FONTES20 1 7 0 8 5 0 1 9 1 1 1 /1 5 /2 0 1 7 0 3 :5 9
KIOSK RECORDING1 0 4 7 3 8 4 -3 -1 -1c a s t i l l o e
a f f i d a v i t o f p e r f o r m a n c e o f a n n u a l w o r k
DO NOT REMOVE
This is part o f the official document
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RETURN RECEIPT REQUESTED
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Receipt Page 1 of 1
United States Department of the Interior Bureau of Land Management
DIV OF LANDS, MINRLS & ENERGY ONE N CENTRAL AVE
Receipt
PHOENIX, AZ 85004 -4427 Phone: 602-417-9200
No: 4047313
Transaction #: 4158713Date of Transaction: 12/21/2017____________________
CUSTOMER:IIr ic h a r d S LAUGHLIN PO BOX 111MORRISTOWN,AZ 85342-0111 US____________
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMSNOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVED CASES: AMC429662/S 10.00
POL 2017/1 - n/a - 10.00
TOTAL: $10.00
PAYMENT INFORMATION1 AMOUNT: 10.00 POSTMARKED: N/A
TYPE: CHECK RECEIVED: 12/20/2017CHECK NO: 153
NAME: LAUGHLIN, RICHARD S PO BOX 111MORRISTOWN AZ 85342-0111 US
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
https://ilmocop0ap933.blm.doi.net/cgibin/cbsp/zorder 12/21/2017
H M [q L S v
5 f as° n f° r filin9 a Notice of Intent to Hold insteed of an assessment work filing (check one)- 5 § J S'in Maintenance fee was paid to maintain claim(s) during this assessment year. ==U Mill or tunnel sites. ’ m□ Claim(s) was located during the current assessment year. : > 1 • <
0 n b ™ 8 ??**■"!? aSf ? sment work <attach “ Py <* decision granting deferment, or pencil petitQn foS 3 deferment including date petition was filed.) " ? ,° TT
LineNo.
A M aNUMBER-» CLAIM/SITE NAME COUNTY RECORDER
DATA (If available) TWP RNG
1— a-1
SEC
1 W i i ? 7 / / 3 0
2
3
4
5
6
7
8
9
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Form: MCF110Revised July 2014
Page I of 2
OLT 19 21
NOTICE OF INTENTION TO O MINING CLAIMS/SITES page 2
1. State of Arizona, County of / .n p c ._________
2 . 1 ( N a m e ) ^ __r A r s ' ______________________
3. Reside at (Address) 3 3 2 (S
ÜLMDateStamp
City a ___________ County mnsirnpe* State fi-*: Zip ¿K*71l~>, being duly sworn, depose andsay that I am a citizen of the United States, mofo than eighteen years of age, that all of the facts set forth in this notice, subject to the provisions and penalties of 18 U .S .C -10Ot pertaining to the filing of false, fictitious, or fraudulent statements with the United States, are true and correct according to the best of my knowledge* information and belief.
4. Owner’s name and address (If not shown in Items 1-3 above).
5. Dated; 7 Signature:
Bureau of Land Management Arizona Stata Office/www.blm.Qov/az
LU C3 j r r n
Form: MCF110 Revised July 2014
Page 2 of 2
This form is available from the Arizona Geological Survey and may be reproduced.
When Recorded Return Di lent to:- / /'< l J ____________________
^ 5 1 0 F- t A i u i u / ^ / ^ w _________________ _
□ Check here is this is a change of address.
Telephone:___
E-mail address:
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK
1. State of Arizona, County of
2 .1 (Nam e)__/ OnnAur UJ l \ 1+
ss:
3. Reside at (Address)
A P 4 - 2 a a u
-3 ^ ( 0 F — LaaI i\Jr 4-y ä
City . County / * V W o » g .
State ^ Z i p 3 .h J \3 >— being duly sworn, depose and say that I am a citizen of the UnitedjStafes^noreTbanu t r ^ n n ^ i f J 8’ f “V i1? fat? Setfortl1 in this affidavit- subject to the provisions and pennies o*18U.S.C. 1001 pertaining to the filing of false, fictitious, or fraudulent statements with the United States, are true and conect according to the best of my knowledge, information and belief.4. Owner’s name and address (If not shown in Items 1-3 above).______________________________
5. That I am personally acquainted with the mining claim(s). The work and improvements were made by and at the expense of the owners) of said claim(s). Said contiguous group of claims, listed on this document, are situated in the
(optional) Mining District;___ M c j r l r s p c » _____________County, Arizona.
LineNo.
AMCNUMBER CLAIM/SITE NAME COUNTY RECORDER
DATA (If available) TWP RNQ SEC
1 H 23L L 3 ö i e - p c - * 7 -rV 3 T/J 3 0
2
3
4
5
6
Form: MCF108Revised July 2014
Page 1 of 2
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK - page 2
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6. Thai between the dates starting at 12 o’clock noon on September 1 ,20 I L and ending at 12 o’clockmoon onSeptember 1, 20 I 7 at least $ / D^>_______ dollars worth of work and improvements were done and performedupon said claim(s) or upon one or more of a contiguous group of claims for the benefit of ail, wholly or partly outside of a contiguous group of claims for the benefit of all, not including the location work,
7. That the following persons were employed to perform the work and improvements described herein:____________
^ _____ _____________________________________________________________________
8. That the work and improvements performed were: Rru<;k Zp > s of______
9. Dated: Signature:r y
SUBSCRIBED AND SWORN TO before me, a Notary Public, this day of / f in j ■ 20 I 7
By: / * t_¿Lep. 1IU - 3 t* u / 3E-
Notary Public_________
My Commission Expires ? -0 7^ 0
CHRISTIANA. ARMENIAMo*«t P u m o - S te le <* A r t » *
MMVCOM COUNTY MfComt GetwAu» 7.20»
Bureau of Land Management Arizona State Office.vww.blm.aov/az
No. of Claims: / X $ 1 0 =s
Check No.: / ( j / ^ / W ( JReceipt No.:F o r BLM Use Only
Form: MCF108Revised July 2014
Page 2 of 2
This form is available from the Arizona Geological Survey and may be reproduced.
Return of Remittance Form Page 1 of 1
UNITED STATESDEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT
ONE N CENTRAL AVE, PHOENIX, AZ 85004-4427 Phone: (602)417-9200
NOTICE OF RETURN OF REMITTANCE
DATE : 09/06/2017 No: 56411
TOMMIE WHEELER
Check Number191
Amount Reference No10.00
Your Remittance(s) listed above is/are returned because of the following reason:
THIS REMITTANCE HAS NOT BEEN SIGNED BY THE MAKER. PLEASE SIGN AND RETURN PROMPTLY TO THIS OFFICE.
Remarks: CHECK #191 IS NOT SIGNED
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Return o f Remittance Form Page 1 of 1
UNITED STATESDEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT
ONE N CENTRAL AVE, PHOENIX, AZ 85004-4427 Phone: (602)417-9200
NOTICE OF RETURN OF REMITTANCE
DATE : 09/06/2017 No : 56412
TOMMIE WHEELER
Check Number192
Amount Reference No10.00
Your Remittance(s) listed above is/are returned because of the following reason:
THIS REMITTANCE HAS NOT BEEN SIGNED BY THE MAKER. PLEASE SIGN AND RETURN PROMPTLY TO THIS OFFICE.
Remarks: CHECK #192 IS NOT SIGNED
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Receipt Page 1 of 1
United States Department of the Interior Bureau of Land Management
DIV OF LANDS, MINRLS & ENERGY ONE N CENTRAL AVE
Receipt
PHOENIX, AZ 85004 -4427 Phone: 602-417-9200
No: 3998630
Transaction #: 4109024Date of Transaction: 10/18/2017____________________
CUSTOMER:¡TOMMIE WHEELER 3320 E UNIVERSITY DR APT 2086 MESA,AZ 85213-8677 US_____________________
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMSNOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVED CASES: AMC429663/$20.00
NOI 2017/1 POL 2017/1 - n/a - 20.00
TOTAL: $20.00
PAYMENT INFORMATION1 AMOUNT: 10.00 POSTMARKED: N/A
TYPE: CHECK RECEIVED: 10/17/2017CHECK NO: 191
NAME: WHEELER, TOMMIE3320 E UNIVERSITY DR APT 2086MESA AZ 85213-8677 US
2 AMOUNT: 10.00 POSTMARKED: N/ATYPE: CHECK RECEIVED: 10/17/2017
CHECK NO: 192NAME: WHEELER, TOMMIE
3320 E UNIVERSITY DR APT 2086MESA AZ 85213-8677 US
____________________________________ REMARKS____________________________________ICUST DID NOT SEND BACK ORIGINAL POL AND NOI/THEREFORE REC'D A COPY FROM [THE RETURN REMITTANCE FILE___________________________________________________This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
https://ilmocop0ap933.blm.doi.net/cgibin/cbsp/zorder 10/18/2017
Run Date: 08/21/17 . r - . . r-.. r-. R unT im e : 09:47 AMDEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT
MINING CLAIMSMC Maintenance Fees Paid Through the BLM Pay Portal
CBS Receipt: 3945712 Printed For Lead File #AMC429662
Agency Tracking ID: 1503122550
Assessment Year: 2018 Number of BLM Serial Nr: 1
Paid On: 08/19/2017 Total Amount Paid: $155.00
Claim NameAGPC-9
BLM Serial No Lead File No Am ount PaidAMC429663 AMC429662 $155.00
NO W ARRANTY IS MADE BY BLM FOR USE OF THE DATA FOR PURPOSES NOT INTENDED BY BLM
Receipt Page 89 of 101
United States Department of the InteriorReceiptBureau of Land Management
BUSINESS & SUPPORT SVCS DIV ONE N CENTRAL AVE SUITE 800
PHOENIX, AZ 85004 -4427 No: 3945712Phone: 602-417-9200
Transaction #: 4055406 Date of Transaction: 08/19/2017
CUSTOMER:llTOMMIE WHEELER 3320 E UNIVERSITY APT 2086 MESA,AZ 85213 US
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMSNOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVED CASES: AMC429663/$ 155.00
- n/a - 155.00
TOTAL: $155.00
PAYMENT INFORMATIONNOTE: Items will appear on credit card statement as "BLM O Mining Claim".
1 AMOUNT : 155.00 POSTMARKED: N/ATYPE: CREDIT CARD RECEIVED: 08/19/2017
NAME: TOMMIE WHEELER3320 E UNIVERSITY APT 2086MESA AZ 85213 US
CARD NO: XXXXXXXXXXXX 8153 AUTH CODE: 090502NAME ON
CARD: TOMMIE WHEELER
EXPIRES: 10/2019SIGNATURE:
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
https://ilmocop0ap933.blm. doi.net/cgibin/cbsp/zorder_search?screen_mode=RECEIPT 8/21/2017
/ ÿ ? * C ‘j'Ü Lfé?ê>^L
Form 3S30-2 (October 2013)
UNITED STATESDEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENTMAINTENANCE FEE WAIVER CERTIFICATI
SEE INSTRUCTIONS ON PAGE 2
FORM APPROVED OMB NO. 1004-0114
Expires: October 31, 2016
This small miner waiver is filed for the assessment year beginning on September 1, 2017_ and ending on September 1. 201?. . . . . . . f ________ i __—ill (,.n«al eitoc InonfpH nnH mmntmnpfl nn Fpnernl I!2. The undersigned and all related parties owned ten or fewer mining claims, milt, or tunnel sites located and maintained on Federal lands in the United States
3. The undersigned have performed1 the assessment work required by law for each mining claim listed prior to filing this waiver and understand that by filing this form, the undersigned must file an affidavit of assessment work with the Bureau of Land Management (BLM) by the December 30th following the filing of this waiver.
4. The undersigned understand that if the assessment work obligation has not yet come due under 30 U.S.C. 28 (for those claims in their first assessment year only), a notice of intent to hold reciting this condition must be recorded by the December 30th following the filing of this waiver.
5. The undersigned understand that mill and tunnel sites may also be listed on this waiver and be waived from payment of the maintenance fee. and that a notice of intent to hold for these sites is required to be filed with the BLM by the December 30th following the filing of this waiver.
6 The undersigned understand and acknowledge that pursuant to 43 U.S.C. 1212 and 18 U.S.C. 1001, the filing or recording of a false, fictitious, or fraudulent document with the BLM may result in a fine of up to $250,000. a prison term not to exceed five years, or both.
------------------------------------------------------------------------------------------------- — -------------
CLAIM OR SITE NAME / BLM RECORDATION SERIAL NUMBER
1. AG PC-8 'ÄMC429662
2.3.4.
5.
6.
7.8.9.
10.
The owner(s) (claimants) of the above mining claims and sites are:
RICHARD S. LAUGHLIN
PO BOX 111(Owner’s Name - Please Print)
(Owner’s Mailing Address)
Signature)
MORRISTOWN(City) (State)
85342(Zip Code)
(Owner's Name - Please Print) (Owner's Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print)
(Owner’s Mailing Address)
(Owner’s Name - Please Print)
(Continued on page 2)
(Owner’s Mailing Address)
............................
(Owner’s Signature)
(City)
~ V-se
co
(Stgte) “ '(Zip Cotte) . JO d .
X .(Owner’s Signature^
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(Owner’s Name - Please Print) (Owner’s Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print) (Owner's Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print) (Owner’s Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print) (Owner’s Signature)
(Owner's Mailing Address) (City) (State) (Zip Code)
18 U.S.C. 1001 and 43 U.S.C. 1212 make it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction.______________________________________________
INSTRUCTIONS1. This certification is made under the provisions of 43 U.S.C. § 1744 and 30 U.S.C. §28-28k and the regulations thereunder (43 CFR Part 3830).2. The claimant(s) must fill in the dates in paragraph 1 for the beginning and ending of the assessment year for which this waiver is sought.3. The claimant(s) must fill in the date in paragraph 2 for the beginning of the assessment year for which this waiver is sought.4. All claim and site names and BLM serial numbers must be listed for the mining claims, mill sites, and tunnel sites for which the waiver is sought.5. All owners of the mining claims, mill sites, and tunnel sites and their addresses must be given.6. This waiver form must be signed by all the claimants or their designated agent, in original form. If an agent is designated, a notarized designation of
agent, signed by all of the claimants with proper address given, must be submitted with this waiver.7. This form must be filed no later than September 1st for the upcoming assessment year in the BLM State Office where the mining claims or sites are
recorded, or the waiver cannot be granted by the BLM. (Example: To obtain a waiver for the assessment year 2012, which begins on September 1,2011, you must qualify for and file for a waiver no later than September 1.2011, in the proper BLM State Office.)
8. For all mining claims which require assessment work, you must record an affidavit of labor on or before the December 30th immediately following the filing of this waiver. For all other mining claims or sites waived, you must record a notice of intent to hold on or before the December 30th immediately following the filing of this waiver.
9. Mill and tunnel sites may also be listed on this waiver and be waived from payment of the maintenance fee. A notice of intent to hold for these sites is required to be filed by the December 30th following the filing of this waiver.
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FOR OFFICIEUSE ONLY
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OFFICIAL RECORDS OF MARICOPA COUNTY RECORDER
ADRIAN FONTES20170625608 0 8 /2 4 /2017 11 .01
KIOSK RECORDING0760022-3-1 -1andricf
MAINTENANCE FEE WAIVER CERTIFICATION
DO NOT REMOVE
This is part of the official document
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L DSTATESForm 3X30-2 DEPARTMENT OF THE INTERIOR r(.Ottober 2013) BUREAU OF LAND MANAGEMENT^
MAINTENANCE FEE WAIVER CERTIFICATION
SEE INSTRUCTIONS ON PAGE 2
FORM APPROVED OM BNO. 1004-0114
Expires: October 31.2016
4 3 0 b e lThis small miner waiver is filed for the assessment year beginning on September 1, 2 0 1 6 and ending on September 1, 2 0 1 7The undersigned and all related parties owned ten or fewer mining claims , mill, or tunnel sites located and maintained on Federal lands in the United States o f A m erica on September 1, 2 0 1 6 .The undersigned have performed the assessment work required by law for each mining claim listed prior to filing this waiver and understand that by filing this form, the undersigned must file an affidavit of assessment work with the Bureau o f Land Management (BLM) by the December 30th following the filing o f this waiver. The undersigned understand that i f the assessment work obligation has not yet come due under 30 U.S.C 28 (for those claims in their first assessment year only), a notice o f intent to hold reciting this condition must be recorded by the December 30th following the filing of this waiver.The undersigned understand that mill and tunnel sites may also be listed on this waiver and be waived from payment o f the maintenance fee, and that a notice of intent to hold for these sites is required to be filed with the BLM by the December 30th following the filing o f this waiverThe undersigned understand and acknowledge that pursuant to 43 U.S.C 1212 and 18 U.S.C. 1001. the fifing or recording of afalse , fictitious, or fraudulent docum ent with the BLM may result in a fine o f up to $250,000, a prison term not to exceed five years, or both.The m ining claims, mill or tunnel sites for which this waiver from paym ent o f the maintenance fees is requested are:
CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER
1. AGPC-8 AMC429662 i /2 AG PC-9 AMC429663
3. AGPC-10 AMC430601
4,
5.
6
7
8
9.10
The owner(s) (claimants) o f the above mining claims and sites are:
PO BOX 111l Owner's Name - Please Print)
----- i \ j .< s . r
MORRISTOWN
---------------------------- 2-----fc— ■-(Owner’s Signature)
AZ
«--^------
85342
(Owner’s Mailing Address) (City) ( State) (Zip Code)
(Owner ’s Name - Please Print) (Owner’s Signature)
iO w ner’s Mailing Address) (City) (State) (Zip Code)
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(O w ner’s Name - Please Print)(—J
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(O w ner’s Mailing Address) (City) * (S ta tjjJ ’ï à Ç l o d e )
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(O w ner’s Mailing Address) (City) (State) (Zip Code)
(Continued on page 2)
(Owner’s Name - Please Pnnt) (Owner’s Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print) (Owner’s Signature) ^ 2wal t
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(Owner’s Mailing Address) (City) Q (Zip Code) r n >y\
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(O w ner’s Name - Please Print) (O w ner’s K ip ia tu r s ^ '
r , ::D ____________ C X __4S#-------
(O w ner’s M ailing Address) (City) (State) O (Z‘P Code)
(O w ner’s Name - Please Pnnt) (O w ner’s Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
18 U.S.C. 1001 and 43 U.S.C. 1212 make it a crime for any person knowingly and willfully to make to any department or agency of the United States any false, fictitious or fraudulent statements or representations as to any matter within its jurisdiction ___________________________________ _
INSTRUCTIONSl . This certification is made under the provisions of 43 U.S.C. § 1744 and 30 U.S.C. §28-28k and the regulations thereunder (43 CFR Pait 3830).2 The claimants) must fill in the dates in paragraph 1 for the beginning and ending of the assessment year for which this waiver is sought3, The claimant(s) must fill in the date in paragraph 2 for the beginning of the assessment year for which this waiver is sought.4 All claim and site nam es and B L M serial num bers m ust be listed fo r the m ining claim s, mill sites, and tunnel sites for w hich the w aiver is sought.5. All owners of the mining claims, mill sites, and tunnel sites and their addresses must be given.6 This waiver form must be signed bv all the claimants or their designated agent, in original form It an agent is designated, a notarized designation of
agent, signed by all of the claimants with proper address given, must be submitted with this waiver,7, This form must be filed no later than September 1st for the upcoming assessment year in the BLM State Office where the mining claims or sites are
recorded, or the waiver cannot be granted by the BLM. (Example: To obtain a waiver for the assessment year 2012, which begins on September 1, 2011, you must qualify for and file for a waiver no later than September 1, 2011, in the proper BLM State Office.)
8 For all mining claims which require assessment work, you must record an affidavit o f labor on or before the December 30th immediately following the filing of this waiver. For all other mining claims or sites waived, you must record a notice oi intent to hold on or before the December 30th immediately following the filing of this waiver
9, Mill and tunnel sites may also be listed on this waiver and be waived from payment of the maintenance fee A notice of intent to hold for these sites is required to be filed by the December 30th following the filing oi this waiver
FOR OFFICIAL USE ONLY
(Continued oil page 3) (Form 3830-2, page 2)
■'\RICOPA COUNTY RECORDER HELEN PURCELL
2 0 1 6 0 5 8 2 2 8 4 0 8 / 1 5 / 2 0 1 6 0 3 : 3 :KIOSK RECORDING
0 6 9 4 2 3 7 - 3 - 3 - 1h e r n a n d ez e
MAINTENANCE FEE WAIVER CERTIFICATION
DO NOT REMOVE
This is part o f the official document
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OFFICIAL RECORDS OF MARICOPA COUNTY RECORDER
HELEN PURCELL2 0 1 6 0 5 8 2 2 8 5 0 8 / 1 5 / 2 0 1 6 0 3 : 3 1
KIOSK RECORDING
0 6 9 4 2 3 7 - 3 - 3 - 2hernandeze
4 2 9 k U 2 .
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AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK
DO NOT REMOVE
This is part o f the official document
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Telephone:
E-mail address:-^ /fî LiCz HT ^ A 1 A i L , £ o M
AFFIDAVIT OF PERFORMANCE OF ANNUAL WORK
1. State of Arizona, County of i^hr A ) C-pft $ ________ss:
I (Name) fìfi Ì\,Ù ^ L t \ l id ' / / LI A / ‘
Reside at (Address) ëûAû2Ull_____
City jyÛgâlÎHhm.County ¡MgicofMState DZ' Zip 4 ~L 'M L - being duly sworn, depose and say that I am a citizen of the United States, more than eighteen years of age, and that all of the facts set forth in this affidavit, subject to the provisions and penalties of 18 U.S.C. 1001 pertaining to the filing of false, fictitious, or fraudulent statements with the United States, are true and correct according to the best of my knowledge, information and belief. _ .4. Owner's name and address (If not shown in Items 1-3 above). <^~A A 7 ^ " " 7 A A /K I j_____
5. That I am personally acquainted with the mining claim(s). The work and improvements were made by and at the expense of the owner(s) of said claim(s). Said contiguous group of claims, listed on this document, are situated in the
AfilXJ OOH //V fcs ffokional) Mining District;_____ A/f) tfl/C0Pi) County, Arizona.
LineNo.
AMCNUMBER CLAIM/SITE NAME COUNTY RECORDER
DATA (If available) TWP RNG SEC
1 f\KPC~9> r , M2 H34UÔ f t & P t . - <7 c V
3 f ix ft- - IO A ’ ¿ 6 k! M i4
5
6
Form: MCF108Revised Jan. 2006
Page 1 of 2
AFFIDAVIT OF PERFORMANC ANNUAL WORK - page 2
7
8
9
10
6. That between the dates starting at 12 o'clock noon on September 1, 20 / ¿T and ending at 12 o’clock noon on September 1, 20 jQ y at least $ O O dollars worth of work and improvements were done and performedupon said claim(s) or upon one or more of a contiguous group of claims for the benefit of all, wholly or partly outside of a contiguous group of claims for the benefit of all, not including the location work.
7 That the following persons were employed to perform the work and improvements described herein:____________
f a c t ' M £ A _________8. That the work and improvements performed were:
„ _____________________________________________
a - V .
9. Dated: « Signature: . ' L ■■3 .7ü y . ^ h l i H £ m | i |
'ublic ^ ^ j p P j V W - — __________
mission Ekpjres__ _______ i t j j j p f l | r Q C j [ U _______________
By:.
Notary Public
My Commission E^pyes
Bureau o f Land Management Arizona State Officewww.az.blm.gov
day ofc. k P u 20 I V/>
Hg\ Jennifer L Penta
Notary PublicM Maricopa County, Arizona / My Comm. Expiree 1 0-29-16
No. o f Claims: , 5>_______x $10 = > < 3 ö -
Check No. : / 3 > ( Init.
Receipt No. : (
For BLM Use Only
Form: MCF108Revised Jan. 2006
Page 2 of 2
This form is available from the Arizona Departm ent of Mines & Mineral Resources and may be reproduced.
This envelope is made from
post-consumer w
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* Domestic only. x For International shipments, the maximum weight is 4 lbs.
TRACKED
INSURED*
UNITED STATES POSTALSERVICE.
PS00001000014
United States Department of the Interior Bureau of Land Management
DIV OF LANDS, MINRLS & ENERGY ONE N CENTRAL AVE
Receipt
PHOENIX, AZ 85004 -4427 Phone: 602-417-9200
No: 3639002
Transaction #: 3742902Date of Transaction: 08/24/2016___________________
CUSTOMER:H r ic h a r d s l a u g h l in
PO BOX 111MORRISTOWN,AZ 85342-0111 US____________
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMS-NOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVEDCASES: AMC429662/$30.00
WAIVER 2017 - 3 /POL 2016-3 - n/a - 30.00
TOTAL: $30.00
PAYMENT INFORMATION1 AMOUNT: 30.00 POSTMARKED: 08/22/2016
TYPE: CHECK RECEIVED: 08/23/2016CHECK NO: 131
NAME: LAUGHLIN, RICHARD STANLEY PO BOX 111MORRISTOWN AZ 85342-0111 US
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
Form 3830-2 (October 2013)
ED STATESDEPARTMENT OE THE INTERIOR
BUREAU OF LAND MANAGEMENTMAINTENANCE FEE WAIVER CERTIFICATION
FORM APPROVED OMBNO. 1004-0114
y Z ? y r y
Expires: October 31.2016SEE INSTRUCTIONS ON PAGE 2
I This small miner waiver is filed for the assessment year beginning on September 1, 2015 and ending on September 1. 2 0 1 6 __2. The undersigned and all related parties owned ten or fewer mining claims . mill, or tunnel sites located and maintained on Federal lands in the United States
of America on September 1. 20153. The undersigned have performed the assessment work required by law for each mining claim listed prior to filing this waiver and understand that by filing this form,
the undersigned must file an affidavit o f assessment work with the Bureau o f Land Management (BUM) by the December 30th following the filing o f this waiver.4. The undersigned understand that if the assessment work obligation has not yet come due under 30 U.S.C. 28 (for those claims in their first assessment year only),
a notice o f intent to hold reciting this condition must be recorded by the December 30(h following the filing o f this waiver5. The undersigned understand that mill and tunnel sites may also be listed on this waiver and be waived from payment o f the maintenance fee. and that a notice of
intent to hold for these sites is required to be filed with the BLM by the December 30th following the filing o f this waiver.6. The undersigned understand and acknowledge that pursuant to 43 U.S.C. 12 12 and 18 U.S.C. 10 0 1, the filing or recording o f a false, fictitious, or fraudulent
document with the BLM may result in a fine o f up to $250,000. a prison term not to exceed five years, or both.7. The mining claims, mill or tunnel sites for which this waiver from payment o f the maintenance fees is requested are:
CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER
L A G P C - 8 A M C 429662
2. A G P C - 9 A M C 429663
3. A G P C - 10 A M C 430601
4- T E N A C IO U S AM C427444 IP S . ~5. CD
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The owner(s) (claimants) o f the above mining claims and sites are:
JA M E S E. H A E R R (C o-ow ne r T enac ious A M C 427444)
(Owner's Name - Please Print)
5166 H W Y 89 S O U TH LIV IN G S T O N M T 59047
(Owner's Name - Please Print) (Owner’s Signature)
(Owner's Mailing Address) (City) (Slate) (ZipCode)
(Owner's Name - Please Print) (Owner's Signature)
(O w ner’s Mailing Address) (City) (State) (ZipCode)
(Continued on page 2)
(Owner's Name - Please Print) (Owner's Signature)
(O w ner’s Mailing Address) (City) (State) (Zip Code)
(O w ner's Name - Please Print) (Owner's Signature)
(Owner's Mailing Address) (City) (State) (Zip Code)
(Owner's Name - Please Print) (Owner's Signature)
(Owner's Mailing Address) (City) (State) (Zip Code)
(Owner's Name - Please Print) (O w ner’s Signature)
(Owner's Mailing Address) (City) (State) (Zip Code)
18 U.S.C. 1001 and 43 U .S.C. 1212 m ake it a crime for any person know ingly and w illfully to m ake to any departm ent or agency of the U nited Stales any false, fictitious or fraudulent statem ents or representations as to any m atter w ithin its jurisdiction.
IN STRU CTIO N S1. This certification is m ade under the provisions o f 43 U .S.C. § 1744 and 30 U.S.C. ij28-28k and the regulations thereunder (43 CFR Part 3830).2. The claim ant(s) m ust fill in the dates in paragraph 1 for the beginning and ending o f the assessm ent year for w hich this w aiver is sought3. The claim ant(s) m ust fill in the date in paragraph 2 for the beginning o f the assessm ent year for w hich this w aiver is sought.4. All claim and site nam es and BI..M serial num bers m ust be listed for the m ining claim s, mill sites, and tunnel sites for w hich the w aiver is sought.5. All ow ners o f the m ining claim s, mill sites, and tunnel sites and their addresses m ust be given6. This w aiver form m ust be signed by all the claim ants or their designated agent, in original form. I f an agent is designated, a notarized designation o f
agent, signed by all o f the claim ants with proper address given, m ust be subm itted w ith this w'aiver7. This form m ust be filed no later than Septem ber 1st for the upcom ing assessm ent year in the BUM State Office w here the m ining claim s or sites are
recorded, or the w aiver cannot be granted by the BLM. (Exam ple: To obtain a w aiver for the assessm ent year 2012. w hich begins on Septem ber 1, 2011, you m ust qualify for and file for a w aiver no later than Septem ber 1, 2011, in the proper BLM State Office.)
8 For all m ining claim s w hich require assessm ent work, you m ust record an affidavit o f labor on or before the D ecem ber 30th im m ediately follow ing the filing o f this w'aiver. For all other m ining claim s or sites w aived, you m ust record a notice o f intent to hold on or before the D ecem ber 30th im m ediately follow ing the filing o f this waiver.
9 Mill and tunnel sites may also be listed on this w aiver and be w aived from paym ent o f the m aintenance fee. A notice o f intent to hold for these sites is required to be filed by the D ecem ber 30th follow ing the filing o f this waiver. “T"? J
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FOR OFFICML USE ONLY
(Continued on page 3) (Form 3830-2, page 2)
U DSTATESForm 3830-2 (October 2013)
DEPARTMENT OF THE INTERIOR BUREAU OF LAND MANAGEMENT I Iej j K
MAINTENANCE FEE WAIVER CERTIFICATION__
SEE INSTRUCTIONS O N PAGE 2
u 3 9 6 6 ? -
W ' f ' f ' f ^>0{°FORM APPROVED OMBNO. 1004-0114
O
Expires: October 31,2016
1. Thin »mall miner waiver is tiled tor the assessment year beginning on September 1, 2015 and ending on September 1, 2016 .2. The undersigned and all related parties owned ten or fewer mining claim s, mill, or tunnel sites located and maintained on Federal lands in the United States
o f America on September 1, 2015 .3. The undersigned have performed the assessment work required by law for each mining claim listed prior to filing this waiver and understand that by filing this form,
the undersigned must file an affidavit o f assessment work with the Bureau o f Land Management (BLM) by the December 30th following the filing o f this waiver.4. The undenigned understand that i f the assessment work obligation has not yet come due under 30 U.S.C. 28 (for those claims in their first assessment year only),
a notice o f intent to hold reciting this condition must be recorded by the December 30th following the filing o f this waiver.5. The undersigned understand that mill and tunnel sites may also be listed on this waiver and be waived from payment o f the maintenance fee, and that a notice o f
intent to hold for these sites is required to be filed with the BLM by the December 30th following the filing o f this waiver.6. The undersigned understand and acknowledge that pursuant to 43 U.S.C. 1212 and 18 U.S.C. 1001. the filing or recording o f a false, fictitious, or fraudulent
document with the BLM may result in a fine o f up to $250,000, a prison term not to exceed five years, or both.7. The mining claims, mill or tunnel sites for which this waiver from payment o f the maintenance fees is requested are:
CLAIM OR SITE NAME BLM RECORDATION SERIAL NUMBER
1. AGPC-8 , / AMC429662
2. AGPC-9 AMC429663
3, AGPC-10 AMC430601 3 S
4 TENACIOUS AMC427444 ® ^5, z r H ^ZZZ 2 - '-rj6.
----------------------------------------- ^ --------- j---------- ---------- -__ j rn
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The owncifs) (claimants) o f the above mining claims and sites are:
JAMES E. HAERR (co-owner Tenacious AMC427444)
(Owner’s Name - Please Print)
5166 HWY 89 SOUTH LIVINGSTON
(Owner’s Mailing Address)
RICHARD S. LAUGHLIN
’s Signature)
MT 59047
(Owner’s Name - Please Print) (Owner’s Sj^ature)
PO BOX 111 MORRISTOWN AZ 85342
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print)
(Owner’s Mailing Address)
(Owner’s Name - Please Print)
(Owner's Mailing Address)
(Owner’s
O ■'-r '- a e -
(City) ïState)
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(Zip C p fe
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(Owner’s Sijign attiré)-: T>,-r /T T rnip ov tî•*n
(City)
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(Owner’s Name - Please Print) (Owner’s Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print) (Owner’s Signature)
(Owner’s Mailing Address) (City) (State) (Zip Code)
(Owner’s Name - Please Print) (Owner’s Signature)
T JCT3
(Owner’s Mailing Address) (City) 3 - “) = (Zip Code)
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(Owner’s Name - Please Print) (Owner's Signature) . t rn
> ; c(Owner’s Mailing Address) (City) M State) (Zip Cdde)
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18 U .S.C . 1001 and 43 U .S.C . 1212 make it a crime for any person knowingly and 'willfully to make to any department or aggm y o f tfatrUnited States any false, fictitious or fraudulent statements or representations as to any matter w ithin its jurisdiction.___________________________________ - Q H',_________
INSTRUCTIONSThis certification is made under the provisions o f 43 U .S .C . § 1744 and 30 U .S.C . §28-28k and the regulations thereunder (43 CFR Part 3830).The c la im an ts) must fill in the dates in paragraph 1 for the beginning and ending o f the assessm ent year for w hich this waiver is sought.The claim ant^) m ust fill in the date in paragraph 2 for the beginning o f the assessm ent year tor which this waiver is sought.A ll claim and site nam es and BLM serial numbers must be listed for the m ining claim s, m ill sites, and tunnel sites for which the waiver is sought.A ll owners o f the m ining claim s, m ill sites, and tunnel sites and their addresses must be given.This waiver form must be signed by all the claimants or their designated agent, in original form. I f an agent is designated, a notarized designation o f agent, signed by all o f the claimants w ith proper address given, m ust be submitted with this waiver.
7. This form must be filed no later than September 1st for the upcoming assessm ent year in die BLM State Office where the m ining claim s or sites are recorded, or the w aiver cannot be granted by the BLM . (Example: To obtain a waiver for the assessm ent year 2012, which begins on September 1, 2011, you m ust qualify for and file for a w aiver no later than September 1, 2011, in the proper BLM State O ffice.)For all mining claim s w hich require assessm ent work, you m ust record an affidavit o f labor on or before the Decem ber 30tb4punedM tcly follow ing the filing o f this waiver. For all other m ining claim s or sites waived, you must record a notice o f intent to hold on or before the;Decembjn^5 Oth immediately follow ing the filing o f this waiver.M ill and tunnel sites m ay also be listed on this waiver and be w aived from payment o f the maintenance fee. A notice o f in tig tto ho
8
9.required to be filed by the Decem ber 30th follow ing the filing o f th is waiver.
r these sites is. rn
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FO R OFFICIAL USE ONLY
(Continued on page 3) (Form 3830-2, page 2)
!/____ t __________ , do hereby give m y permissionto, and appoint /fL \rk n rJ ¡ '„ ______ as my authorizedrepresentative, to act as agent in my behalf for ail our jo in t dealings with the Bureau of Land Management.
CLAIMANT DATE
STATE OF
COUNTY OF r r \x r t copg
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On the IT day of t*j_______ , 20 /*Y . personally appearedbefore me. A Notary Public in and for the above state and county,i j i t e x s £ U a^rr~________________, known to me or proved to be theperson named in and who executed the foregoing instrum ent, and being first duly sworn, such person acknowledged that he or she executed said instrum ent for the purposes therein contained as his or her free and voluntary act and deed.
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OFFICIAL RECORDS OF 1ARICOPA COUNTY RECORDER
HELEN PURCELL2 0 1 5 0 3 8 4 3 3 3 0 5 /2 9 /2 0 1 5 0 3 :1 2
KIOSK RECORDING
0 4 1 8 3 6 0 - 3 - 2 - 2 r o g e r s j
NOTICE OF INTENTION TO HOLD MINING CLAIMSISITES
DO NOT REMOVE
This is part o f the official document~o • • /ocG> i~nm C— . >2 cm2T !
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NOTICE OF INTENTION TO HOLD MINING CLAIMS/SITES When Recorded Return Document to: .
n e r v i s m * ; , i f 7 .
□ Check here if this is a change of address.Telephone: / ) ____
E-mail Address: S L A U S tiD /J L f 2 ¿ 0
I (W e) intend to hold the claims(s) and/or site(s) listed below for the calendar year 20/ h and I (W e) have f il^ o r wi file a Notice of Intent to Hold in the county where the claim (s) is located. zReason for filing a Notice of Intent to Hold instead of an assessment work filing (check one): ><□ Maintenance fee was paid to maintain daim (s) during the assessment year.□ Mill or tunnel sites.
£ ) Claim(s) was located during the current assessment year.□ BLM has deferred assessment work (attach copy of decision granting deferment, or pending petition for o
deferment including date petition was filed.) z
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LineNo.
AMCNUMBER CLAIM/SITE NAME COUNTY RECORDER
DATA (If available) TWP RNG SEC
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Form: MCF110Revised July 2014
Page 1 of 2
2015 JUN - I
A !0: U
S
NOTICE OF INTENTION TO HOLD MINING CLAIMS/SITES page 2
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1. State of Arizona, County of Ï'^i A / K Ï / J 'D H /r? ______________
2 .1 (Name)
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..... ___ Jo Aox m_________________City M ()Ç $ A vmlCount 'Hi/HCOtH-state / / ¿ f Zip being duly sworn, deoosdarxtsay that I am a citizen of the United States, more than eighteen years of age, that aU of the facts set forth in this notice, subject to the provisions and penalties of 18 U.S.C. 1001 pertaining to the filing of false, fictitious, or fraudulent statements with the United States, are true and correct according to the best of my knowledge, information and belief.
Bureau of Land Management Arizona State Officewww.blm.aov/az
No. of Claims: „ ^ _____ x $10 —$ 7Ô - c >Check No: I N ? - _Imt _Receipt No.: 3 3 / ^ -3For BLM Use Only
Form: MCF110Revised July 2014
Page 2 of 2
This form is available from the Arizona Geological Survey and may be reproduced.
2015 JUN - I A
I0: ^0
Page 1 of 1
United States Department of the Interior Bureau of Land Management
LANDS/RECREATION & PLANNING ONE N CENTRAL AVE
Receipt
PHOENIX, AZ 85004 -2203 Phone: 602-417-9200
No: 3312349
Transaction #: 3409454Date of Transaction: 06/02/2015____________________
CUSTOMER:IIr ic h a r d s l a u g h l inPO BOX 111MORRISTOWN,AZ 85342-0111 US____________
LINE# QTY DESCRIPTION REMARKS UNIT
PRICE TOTAL
1 1.00
LOCATABLE MINERALS / MINING CLAIMS-NOT NEW-UNADJUD,ONE AUTH NO. ONLY / MINING CLAIM MONEY RECEIVED CASES: AMC429662/$70.00
MAINT FEE WAIVER (4) 2016/ NOI (3)2015
- n/a - 70.00
TOTAL: $70.00
PAYMENT INFORMATION1 AMOUNT: 70.00 POSTMARKED: 05/30/2015
TYPE: CHECK RECEIVED: 06/01/2015CHECK NO: 1142
NAME: LAUGHLIN, RICHARD STANLEY 3296 HARDEE AVE CHAMBLEE GA 30341 US
REMARKS
This receipt was generated by the automated BLM Collections and Billing System and is a paper representation of a portion of the official electronic record contained therein.
r w
* J i ( l S
6/2/2015
Please process and file the enclosed paperwork.
Return To:
Richard S. Laughlin
PO Box 111
Morristown, AZ 85342
Thank you.
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OFFICIAL RECORDS OF IRICOPA COUNTY RECORDER
HELEN PURCELL2 0 1 5 0 3 8 4 3 3 2 0 5 /2 9 /2 0 1 5 0 3 :1 2
KIOSK RECORDING
0 4 1 8 3 6 0 - 4 - 2 - 1r o g e r s j
MAINTENANCE FEE WAIVER CERTIFICATION
DO NOT REMOVE
This is part o f the official document~ 0r comz r .
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PLEASE PRESS FIRMLY PLEASE PRESS FIRMLY
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UNITED STATES POSTAL SERVICE
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UNITEDSTATES POSTAL SERVICE® shipping servies on ebay
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05/30/2015 From 85342
U S P O S T A G E PAID P itney Bow es C o m B a sP r ic e
Flat Rate Envelope
024P0007617919
PRIORITY MAIL 1-DAYCaptDick Enterprises.Net PO Box 111 Morristown AZ 85342
Delivery Date: 06/01/2015
0006
£ 0 4 1BUREAU OF LAND MANAGEMENT 1 N Central Ave Ste 800Phoenix AZ 85004-4427
USPS TRACKING #
9405 5096 9993 9978 0474 75
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This packaging is the property of the U.S. Postal Service® and is provided solely for use in sending Priority Mail® shipments.Misuse may be a violation of federal law. This packaging is not for resale. EP14F-P-PP © U.S. Postal Service; June 2012; All rights reserved.
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NOTICE!!
These documents have been scanned!
Do not place un-scanned documents beneath this notice! Do not remove this notice from this file!
GPO Jacket No. 560-102 Print Order 61540
Rise Business Services, LLC Job=AZ15 5 /1 0 /2019
Box Number= AZ15031
Claim Begin-End: AMC429662-AMC429663
5 Miscellaneous
AZ15031 -20 AMC429540-AMC429995
AZ15031
AMC429662-AMC429663
BREAK
R eversal Confirm ation P age 1 o f 1
!MAC4?°ifcG2Authorized Date08/07/2015
AZ BLM REFUND $40 TO RICHARD STANLEY LAUGHLIN FOR Instructions to AccountsOVERPAYMENT OF 2015 NOI PROCESSING FEE FOR AMC429662.
RECEIPT#3312349. [email protected] ID4105
Entry Date08/07/2015 Total Amount$40.00
http://ilmnirm0ap301/cgibin/cbsp/zorder_search?screen_mode=AUTH 8/7/2015
9/21/2015 ' D E PA R TM EN T OF T H E IN TER IO R Mail - Fwd: CBS Cancelled Check
Ebert, Rodney <[email protected]>
Fwd: CBS Cancelled Check (r IfHouston, Annabell <[email protected]> To: Rodney Ebert <[email protected]>
Rod,
Mon, Sep 21, 2015 at 11:17 AM
The Refund check below was returned to Treasury.
Regards,
Annabell HoustonAccounting Technician, CBS Core Team LeadInformation Access CenterAZ State Office - Bureau of Land Management1 North Central Ave, Suite 800Phoenix, AZ. 85004-4427Tel.: 602-417-9562Fax: 602-417-9556
--------- Forwarded message----------From: <[email protected]> Date: Mon, Sep 21, 2015 at 4:00 AM Subject: CBS Cancelled CheckTo: [email protected]: [email protected]
Treasury cancelled the refund check listed below. The funds are back on your original transaction. Determine why Treasury returned the refund check. Either start the three step refund process again to a corrected address or carefully follow the procedures on unclaimed money described in the Unclaimed Money Instruction Memorandum for the current fiscal year.
If this cancelled check refunded a Declining Deposit Account (DDA), the automatic cancelled check interface updated the DDA status and balance. The DDA will be in ready state to refund again. If you transfer to Unclaimed Money, you will have to go into DDA Management and manually close the DDA after you complete the transfer.
For more details regarding this cancelled refund check please refer to the Cancelled Refund Check Report.
RICHARD STANLEY LAUGHLIN 3296 HARDEE AVE CHAMBLEE, GA 30341-3308
Transaction No Refund Date CBS Doc No Fund Code Amount Receipt Org
https://mail.google.com/rn ail/u/Q/?ui=2&ik=a97aa3f2ba&view= pt&search=inbox&msg= 14ff11faf86ffada&siml= 14ff11faf86ffada 1/2
9/21/2015 " '"P A R T M E N T OF T H E IN TER IO R Mail - Fwd: CBS Cancelled Check
3409454 08/12/2015 31- 8 XXXL6500DP $40.00 LLAZ931
Please contact the CBS Customer Service Desk at 303-236-6795 if you need assistance.
This email was generated by the automated Cancel Refund Check Interface between FBMS and CBS. Database = cbsp.
https://mail.google.com/rn ail/u/0/?ui=2&ik=a97aa3f2ba&view=pt&search=inbox&msg=14ff11faf86ffada&siml=14ff11faf86ffada 2/2
9/21/2015 '■''■PARTMENT OF T H E IN TER IO R Mail - Fwd: CBS Cancelled Check
Ebert, Rodney <[email protected]>
Fwd: CBS Cancelled Check
Houston, Annabell <[email protected]> To: Rodney Ebert <[email protected]>
Rod,
Mon, Sep 21, 2015 at 11:17 AM
The Refund check below was returned to Treasury.
Regards,
Annabell HoustonAccounting Technician, CBS Core Team LeadInformation Access CenterAZ State Office - Bureau of Land Management1 North Central Ave, Suite 800Phoenix, AZ. 85004-4427Tel.: 602-417-9562Fax: 602-417-9556
--------- Forwarded message----------From: <[email protected]> Date: Mon, Sep 21, 2015 at 4:00 AM Subject: CBS Cancelled CheckTo: [email protected]: [email protected]
Treasury cancelled the refund check listed below. The funds are back on your original transaction. Determine why Treasury returned the refund check. Either start the three step refund process again to a corrected address or carefully follow the procedures on unclaimed money described in the Unclaimed Money Instruction Memorandum for the current fiscal year.
If this cancelled check refunded a Declining Deposit Account (DDA), the automatic cancelled check interface updated the DDA status and balance. The DDA will be in ready state to refund again. If you transfer to Unclaimed Money, you will have to go into DDA Management and manually close the DDA after you complete the transfer.
For more details regarding this cancelled refund check please refer to the Cancelled Refund Check Report.
RICHARD STANLEY LAUGHLIN 3296 HARDEE AVE CHAMBLEE, GA 30341-3308
Transaction No Refund Date CBS Doc No Fund Code Amount Receipt Org
https://mail.google.com/rn ail/u/0/?ui=2&ik= a97aa3f2ba&view= pt&search=inbox&msg= 14ff11faf86ffada&siml= 14ff11faf86ffada 1/2
9/21/2015 ' r' ,_PARTMENT OF THE INTERIOR Mail-Fwd: CBS Car—'led Check
3409454 08/12/2015 314 5 XXXL6500DP $40.00 LLAZ931
Please contact the CBS Customer Service Desk at 303-236-6795 if you need assistance.
This email was generated by the automated Cancel Refund Check Interface between FBMS and CBS. Database = cbsp.
https ://m ai I .google.com/m ai l/u/0/?ui= 2&i k= a97aa3f2ba&vi ew= pt&search= i nbox&m sg= 14ff 11 faf86ffada&si m I=14ff11 faf86ffada 2/2
• M C U pdate A ction D etails Page 1 o f 1
Action Code Update
Serial-No: AMC429662 Status: ACTIVE
Bottom of Screen
Del? Date (mm/dd/yyyy) I Code Action Taken Action Remark Receipt Nr Ins l® 1 □ x 09/25/2014 r d| 403 |l o c a t i o n d a t e ¡R M ATT
O 2 □ x 11/06/2014 1 i 305 R E C O R D A T IO N N O TIC E R E C D \ ~ ¡CBS_.IL
O 3 □ x 08/28/2015 i 1483 S M A LL M IN E R C E R T F ILE D (2016 | r e b e r
O 4 □ X 08/07/2015 □ j 379 R E F U N D A U T H O R IZ E D |$ 4 0 ;O V E R P D NOI ¡3312349 ¡R E B E R
0 5 □ x 06/01/2015 1 u| 913 M A IN T W A IV E R D O C F ILE D |2 0 1 6 1 RM ATT
O 6 □ x 06/01/2015 I 1481 N O TIC E O F IN TE N T TO H O LD ¡2015 |3 3 12349 |R M ATT
0 7 □ x 04/08/2015 [ 669 LA N D S T A T U S C H E C K E D ¡R EB ER
O 8 □ x 11/06/2014 [ ul 501 A C C T A D V IN LE A D FILE ¡A M C 42 9 6 6 2 -A M C 4 2 9 6 3 3 ; ¡RM ATT
O 9 □ X 11/06/2014 m 484 LO C A T IO N Y E A R / M A IN T E N A N C E FE E |2 0 1 5 ;$ 1 5 5 ¡3164646 1 RM ATT
0 10 □ x 09/30/2014 404 C O U N T Y R E C O R D A T IO N (2014-0647 443 ; |R M ATT
# Actions: 10Provide me with n s new occurrences
Please SAVE&CONTINUE Between DELETES and NEW/CHANGE LinesSave & Continue | Save & Exit I Cancel I Lookup
Serial-No: AMC429662
Top of Screen
http://ilmnirmOapl 51:9000/cgi-pro/lr2000_510/ltsrpl ts?@webid=6c37Ena4gg-145511066... 2/10/2016
R eversal C onfirm ation P age 1 o f 1
Authorized Date02/12/2016_ . AZ BLM REFUND TO RICHARD LAUGHLIN $40.00 FORInstructions to Accounts o v e r p a y m e n t OF FEES ON AMC429662 RECEIPT #3312349. IR
Login ID6771 Entry Date02/12/2016
Total Amount$40.00
http://ilmnirrn0ap301/cgibin/cbsp/zorder_search?screen_mode=AUTH 2/12/2016
NOTICE!!
These documents have been scanned!
Do not place un-scanned documents beneath this notice!
Do not remove this notice from this file!
GPO Jacket No. 560-102 Print Order 61540
Rise Business Services, LLC Job=AZ15 5 /1 0 /2 0 1 9
Box Number= AZ15031
Claim Begin-End: AMC429662-AMC429663
6 Location Notices-Amendments and Supporting Documents
AZ15031-20 AMC429540-AMC429995
AZ15031
AMC429662-AMC429663
BREAK
m ining claim status report
Data Entered: / / / ! MTP Checked By: j / J 'fz ./ /yGEO Checked By: i f / / z //</
LEAD SERIAL NUMBER: AMC ^ th ru AMC ^ fa fa. 3
NUMBER OF CLAIMS & TYPE: CHARGES:
____________ LODE
"X PLACER
____________ ASSOCIATION PLACER
____________ MILL SITE
____________ TUNNEL SITE
TOTAL ACREAGE: <? O ________ Per Claim _(Placer Only)
NUMBER OF LOCATORS: /
DOCUMENTS RECEIVED VIA : Over-the-Counter [ ] Mail [
LEGAL DESCRIPTION: T R SEC
T ____________ R SEC
T ____________ R SEC
T ____________ R SEC
T ____________ R SEC
BLM [ ] FOREST SERVICE [ ] _________________________________ SUBJ TO PL 359: Yes [ ] No [ ]
WILDERNESS AREA [ ] ____________________________________________________________________
SPLIT ESTATE: N/A [ ] SX [ ] PX [ ] OTHER [ ] ________________________________________________
SRHA [ ] Was proper Notice filed if located on SHRA Land? Yes [ ] No [ ]
RECONVEYED MINERALS ON BLM LAND REQUIRE OPENING ORDER FROM 1944 TO 1993:
Open to Entry On ______________________ N/A [ ]
COMMENTS/STATUS: VOID [ ] PARTIALLY VOID [ ] PVT MINERALS [ ] WITHDRAWN LANDS [ ]
OTHER [ ] ___________________________________________________________________________
Location Fee @ $37 = $ Lfa . (J(^ )
Processing Fee @ $20 = $ tfafafa) cQfafa)
Maintenance Fee @ $155 = $ < f a [ ( ) - ( fa fa J
Add'l Maint Fee for Assoc Placer = $
SUBTOTAL ypL1/ -¿X)
0t ' V .
Other Fees
Other Fees
TOTAL
TIMELY FILED: Yes I
$ ~ck tf. c)( )
No
[ ] Claimant acknowledges that portions of the following claim(s) slte(s) may be void or voidable.
P rinted Name o f C laim ant Signature o f C laim ant
* * * * * * * * * * * * * * * * * * * * p | | ^ ^ L A D JU D IC A T IO N ****** * * * * * * * * * * * * * *
DATE l-\ ~ \ j S INITIALS
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OFFICIAL RECORDS OF MARICOPA COUNTY RECORDER
HELEN PURCELL2014-0647443 09/30/14 01:31 PM
PAPER RECORDING
0758919-2-2-2henrya
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LOCATION NOTICE FOR PLACER MINING CLAIM
□ Amendment BLM Serial #
NOTICE IS HEREBY GIVEN that the /} J3 P %_______
____________________ _ placer mining claim has been located by
l/llL P~rjlLl/l) whose current mailing
address is. Pl A L L IL ____________________________
m m 6.im . ^ a z . $5L ? 4 2The general course of this claim is h m iL m a H and it is situated in
NOCJ1
County, Arizona. This claim is !3PD feet in length and fo&O feet In width
M . Total Claim Acreage. This claim runs from the location monument on which this location notice is
posted at the hi & comer of the claim aDDroximately f P L j feet in a S _ direction to the
— j£.___ end line and O feet in a \/J _ direction to the \AJ______end line. This claim is
marked by four monuments, one at each comer of the claim.
The location monument on which this notice is posted is situated within Section . Township
P L JP - , Range 1/iP , Gila Salt River Base and Meridian, Arizona. This claim encompasses
portions of the following legal subdivision(s) if located by legal subdivision or the following quarter section(s),
section(s), Township(s) and Range(s) jL ' /x lO £ h v £ ]/4 c? oX L U L K LA aL______________________ _______,Gila Salt River Base and Meridian, Arizona.
The locality of this claim with reference to some natural object or permanent monument and additional information
jifa n y ) concerning its locality are as follows: fJPl-P/hA / j S /) ~TJJLtL Lj£.&S P A / L A m L P L S & L m /?¿Ml l 4
v y_The above information is shown on the attached map.
DATED AND POSTED on the ground this jXPTi) day of SBffPAlAS)Ÿ. 20 } tf'.JS LOCATOR(s) □ AGENT
Print Name(s)
Signatures) ------------------ -, w r u ~ I F. ----------------------- Fornl MCF102
Revised July 2014
This form is available from the Arizona Geological Survey and may be reproduced.
AH
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MINING CLAIM MAP
1 mile
S^TIoaJ ) 1
1
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NE UO
SW
■£307*7//
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Lode ( ) Placer Millsite ( )
SZ TtcP'O 2V
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. rn: o rn
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AScale: 1" = 2000 feet ' N
1. The above map depicts the A&PK.-« __mining claim, which is located in Section (s)
2 /9------ . Township _Q_______/[J , Range ^ l\J , Gila and Salt River Base and Meridian
MM1A12M _ County, Arizona. Total claim acreage is _______ 72. 7) A £7)2. The type of comer and location monuments used are as follows: ¿TL/l PPff/O 7
[AjiT/l__ /)L /m I/UU / 7 1/4 (2S _____________________________________
3. The bearings and distances in degrees and feet between claim comers and to a public land survey monument
are as depicted on the map.
4. If the claim is a placer or millsite claim with exterior limits conforming to legal subdivisions of the public survey,
provide a legal description of the claim f- /*?_ AzC H A L K 2 >u L
Form MCFlOOaRevised July 2014
This form is available from the Arizona Geology Survey and may be reproduced.
2<m
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OFFICIAL RECORDS OF MARICOPA COUNTY RECORDER
HELEN PURCELL2014-0647442 09/30/14 01:31 PM
PAPER RECORDING
0758919-2-2-1henrya
LOCATION NOTICE FOR PLACER MINING CLAIM
□ Amendment BLM Serial #
}T 5 r-o
c=> "■*I C s z r : t.
r n Z ZCD 3
BLM j t -
Date > < ic r
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Stamp T ï
2 T 3 Jn
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NOTICE IS HEREBY GIVEN that the f\lA PS — ^7 _______
_____________________placer mining claim has been located by
i<!/0 Utn whose current mailing
address is. ¿ Q . H L ____________________________
iM oPPiPTD^y.The general course of this claim Is and it Is situated In
County, Anzona. This claim is J P.AA) feet in length and feet in width
3j i . Total Claim Acreage. This claim runs from the location monument on which this location notice is
posted at the ¡\J& comer of the claim aoproximately ATf in a _ direction to the
^ end line and bfaO feet in a vJ direction to the _ J d Z end line. This claim is
marked by four monuments, one at each comer of the claim.
The location monument on which this notice is posted is situated within Section c . Township
i AJ- — . Range IaJ , Gila Salt River Base and Meridian, Arizona. This claim encompasses
portions of the following legal subdivision(s) if located by legal subdivision or the following quarter section(s),
section(s), Township(s) and Range(s) w b y* % S B O m l -2 F-r n /J £ 3 u i ______________________ _______ ,Gila Salt River Base and Meridian, Arizona.
The locality of this claim with reference to some natural object or permanent monument and additional information
(if any) concerning its locality are as h/pZj
LlojO iiL/ZM i _The above information is shown on the attached map.
DATED AND POSTED on the ground this 'Ijo'T}) day o y? , 20 ) f~ .
J% LOCATOR(s) □ AGENT
Print Name(s) jyy^ jy ~7f /) FF 4 // £ iM . s \\L I/O¿ y J ---------------------- Forni MCF102
- F Revised July 2014
This form is available from the Arizona Geological Survey and may be reproduced.
3 > .
O-c r
N J- Oc r c7- Lxt
* 1 mile -------
MINING CLAIM MAPLode ( ) Placer po
/¿ j
▲ ; u
: £
NW 1 r
X
o‘E
! (iiii
¿ ¿ 7X -
3? s :05c
T—■•i x , *■>'—\
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ii■SW j SE
11
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E5 TJ 'r n r-i ,) e ji W ":l
ß , f
AScale: 1" = 2000 feet N
1 The above map depicts the — ft lo A ________ mining claim, which is located in Section (s)
3 0 , Township M._____ &L. , Range J2-J& L , Gila and Salt River Base and Meridian,
J-dl$ A) LO& i County, Arizona. Total claim acreage is ________^
2. The type of comer and location monuments used are as follows: A P.PEX) 2.H C iaS/TH rftiJM! VUM IN K S ___________________
3. The bearings and distances in degrees and feet between claim comers and to a public land survey monument
are as depicted on the map.
4. If the claim is a placer or millsite claim with exterior limits conforming to legal subdivisions of the public survey,
provide a legal description of the claim UJ h h /ft W t i f t Yu- ZZ.O
-TO A / g Jd A l f c S R A ' i M ____________________Form MCFlOOa
Revised July 2014This form is available from the Arizona Geology Survey and may be reproduced.
RUNTIM E: 01:24PM
Case D isp Txt
Total Rows Returned: 2
DEPARTMENT OF INTERIOR BUREAU OF LAND MANAGEMENT
Input Parameters for Geographic Report with Land
RUN DATE:
System Id = CR
Adm in State = AZ
Geo State =
Casetype B egins W ith
AUTHORIZED, CANCELLED, EXPIRED, PENDING, REJECTED, RELINQUISHED, WITHDRAWN
Mer Twp Rng =
Section =
M trs = 14 0070N 0030W 030, 14 0070N 0030W 999
C om m odity =
C om m odity Txt =
Pending Org =
Pend Org Decode =
11/12/2014
Page 1 o f 1
NO WARRANTY IS MADE BY BLM FOR USE OF THE DATA FOR PURPOSES NOT INTENDED BY BLM
UNITED STATES DEPARTMENT OF INTERIOR RUN DATE: 11/12/2014BUREAU OF LAND MANAGEMENT Page 1 o f 1
GEOGRAPHIC REPORT WITH LAND Sorted by Serial Num ber
Serial Num ber: AZA 031568Total Case Acres: 1.000
Casetvoe Case Diso 14 0070N 0030W Sect Sur Tvp Sur Num Suff S ubd iv is ion A ct Pend
293200 EXPIRED 030 FF PO R TIO N OF;
Serial Num ber: AZA 031961 Total Case Acres: 1.000
Casetvoe Case Diso 14 0070N 0030W Sect Sur Tvo Sur Num Suff S ubd iv is ion A ct Pend
293200 EXPIRED 030 FF PO R TIO N OF;
Serial Num ber: AZA 036537 Total Case Acres: 1.000
Casetvoe Case Diso 14 0070N 0030W Sect Sur Tvo Sur Num Suff S ubd iv is ion A ct Pend
380913 A U TH O R IZED 030 ALIO E2SESE; Y
RUNTIM E: 01:24 PM
Adm State: AZ
TOWNSHIP 7 NORTH RANGE 3 WEST OF THE GILA AND SALT RIVER MERIDIAN, ARIZONA
I— 19
---------301!*’ l
« 38. *1 f
4 38.67'
Lot
WASHING STATEMENTi>l» plot I# the Bureou's Rocord o' Title, ond should Oc wood
o"ect«d by oterol movoo-ootj o' riverj or other bodle« el wotor.
STATUS OF PUBLIC DOMAIN LAND AND MINERAL TITLES
INDEX TO SEGREGATED TRACTS
ORIGINAL SURVEY
FOR ORDERS AFFECTING DISPOSAL OR USE OF_______UNIDENTIFIED LANDS WITHDRAWN FOR CLASSIFICATION, MINERALS, j VATER AND/OR OTHER PUBLIC PURPOSES, REFER TO INDEX OF MISCELLANEOUS DOCUMENTS.
D/ST NO 2
MDS 25 J NE 254 NW
33'53'46'N
112'31’O rW
CURRENT TO
1 -2 6 -2 0 0 5
BTT
R
7 N
3 W