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4iiiesweei5 63.5404 GARSON 010
SUMMABT OF INVOICES
Hainville Luther Co. Ltd.
trench 11
Trench 12
Trench 13 Trench 1 4 Trench 15
Trench 16
his.
July 11,July 12,July 13,July 14,July 16,July 16,July 17,July 18,July 19,July 20,July 21,July 23,July 24,July 25,July 26,July 27,Aug. B,
1990199019901990199019901990199019901990199019901990199019901990
1990
Invoice
07970798079908000801080208030804082108220823082408450846084708510899
600.00 720.00 720.00 360.00 360.00 180.00 850.00 760.00 720.00 720.00 600.00 480.00 120.00 720.00 600.00 540.00
-12LM( CREDIT)
P.P. Larche Mining Exploration
Clans 1025408 and 1025409'-
Aug. 3 - Aug. 10,1990
0030
TOTAL: 8930.00
6650.00
NET TOTAL: J15580.00 - 1558 days
SUMMAfi! OF MIXING REPORTS
Dave Claiaed 504 314 400 340
TOTAL: 1558 days
(705) 268-7793 D.P. LARCH EMINING EHPLORflTION
l POWER STRIPPING A TRENCHING ||
P.O. Box 1394 Timmins. Ontario P4N 7N2
INVOICE NO. 0 030
Fa.lconbr.id.ge...Ltd...cX.oMj:......Stewar.t...Gibbins DATE OF INVOICE:
S.u.ifce . 2.02. .-... 1.2.4.... C.e.dar....S.t.r.e.e.t.............. CUSTOMER NO.: ...
Sudbury. Qnfc P.3.E...lb.4........................................ ...............................
.. AUG... 3... T.D.. AUG... 10......
f
l. 1
2
-•-—H-H4- — 1
--—
-
^
— Str ipp-Lng — suftd — Trenching — E a 1 c o n-b-r-i d-c^e— -P-i^op&^fc-y --- -Project # 0 3 1 ^ V7a li*.-/ pa ^} CU-AI^S lO-z.S'-foj? ^
' (Ot-S-fO^
S.I Muskeg mounted. Backhoe incl Fuels @ 50. HrDozer 450C Mounted Backhoe incl Fuels @ SO.Hr(^pgp^'pQp^ ^ ^25 HP
Total
# T^S -U+^l UoUcley 0.11 C0 0^(C d 0l^e O v, Tre^tU *7 ( ^^
WUI e. S ,o*rk ow Trtn^U^r * ; 3 S c^J C,
-
.
50Hr
120 Hr4 5 D
A
$700 .
,. n n n
J'erms: Net 15 days - 214 interest per month ( 24'h p er annum) charged on overdue accounts.
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VALLEY EAST CLAIM BLOCK
TRENCH GEOLOGY
10V. frags, her*
- up to 10V. of surface Is pitied - 5mm-3cm pits, lcm ove.
f 4 POSt CL
no. of frags, difficult lo determine rocks are harder here
EDGE OF TRENCH i
SCALE l- 250
- g rey lo black ws,. greenish grey fs.-fine grained matrix ,- subangular lo rounded fragments
-5-7V.. 2mm-IOcm, 10mm ave,- mainly quarlzitic; some chert frags.,.
- chlorite alteration present J- c arbonate alteration associated
with some frogs.-up to IV. pyrrhotite '
LEGEND
Grey Member (Onaping Formation), - intermediate tuff^ ^
tom
S. M CKINLEY, JULY/90
MAI
NVI
LLE
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MPA
NY
LIM
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R.R.
#2,
Site
14,
Box
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#2,
Site
14.
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5CH
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SFO
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POM
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Site
14,
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5C
HEL
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02.
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14,
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5CH
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SFO
RD.
ON
TAR
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OM I
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855-
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\':H
: '-i
f K
IES
610
AM
OU
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l
VALUE. T C.M3 l ULAIIVI
TRENCH GEOLOGY
WHITE BRECCIA UNIT- buff to black ws., buff fs.- up to 85V. quartzite blocks
- 2cm-lml 10cm ave.- many of the blocks are flow banded
- matrix is medium grained and appears to be granophyre
- up to 10V. Imm light blue quartz eyes In matrix
•w-
CLM. I02540& ^ 115m l ISO'":
- rocks hare appear to have a higher mafic content- may be due to their finer texture
and/or alteration
OUTLINE OF TRENCH
GRANOPHYRE- pink to light brown ws.. often rusty- grey and brown fs.- medium to coarse grained- up to 50V. K-feldspar- I5-2OV. quartz, often in the form of light
blue translucent eyes- Up to 30V. mafic - mainly hornblende
- much appears to be altered to chlorite- trace Po/Py
LEGEND
White Breccia Unit- sedimentary
Granophyre- Igneous intrusive
SCALE 1:250
10m
MAI
NVI
LLE
LUM
BER
CO
MPA
NY L
IMIT
EDR
R. #
2, S
ite 1
4, B
ox 5
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, O
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one
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2577
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SE
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S 6
10
AM
OU
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NY
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R.R
#2,
Site
14.
Box
5CH
ELM
SFO
RD.
ONT
ARIO
POM
l LO
Phon
e 85
5-25
77
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ST
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0803
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goods
MU
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panie
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vc/i-
f SE
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S 61
0
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NVI
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BER
CO
MPA
NY
LIM
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R.R.
#2,
Site
14,
Box
5CH
ELM
SFO
RD,
ONT
ARIO
POM
1LO
Phon
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5-25
77
QT
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by
this
bill
.
SER
IES
610
AM
OU
NT
l (TO
QJew
VALLEY EAST CLAIM BLOCK
TRENCH GEOLOGY
-/k-
- grey-brown ws., greenish-grey fs.- fine grained matrix- 7-IOV. fragments
- 2-l5mm, 3mm ave.- ahdesltlc and quartzitic In composition,
-~IV. ll.blue quartz eyes ' "- trace pyrrhotite- chlorite alteration
EDGE OF TRENCH
CLAIM 1025408
CLAIM 1025409
INFERRED CONTACT
'26m l 270*
*2 POST
CLM. 1025408
LEGEND
Grey Member ( Onaping Formation) - intermediate luff
Amygdaloidal Andesite
- grey-brown ws., greenish-grey fs.- aphanitic matrix- 7-IOV* amygdules
- white to beige colour- mainly quartz- lmm-5mm, 3mm ave.
-~3V. light blue quartz eyes- ru*iy spots, but no visible sulphides- chlorite alteration In places
SCALE l TO 125
5m
S. MCKINLEY. JULY/90
MAI
NVI
LLE
LUM
BER
CO
MPA
NY
LIM
ITED
R.R.
K2,
Site
14,
Box
5CH
ELM
SFO
RD,
ON
TAR
IO P
OM 1
LOPh
one
855-
2577
f
CU
ST
OM
ER
'S O
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ER
N
O.
PH
ON
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Y.
CAS
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SE
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r\ C
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and
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MU
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bc
accom
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ill.
•tin
* SE
RIE
S 61
0
l
VALLEY EAST CLAIM BLOCK
TRENCH GEOLOGY
QUARTZ VEIN
QUARTZ VEIN
SYMBOLS
"—'—" Inferred contact------ edge of trench-—* —" claim line
- grey-brown ws., greeenlsh-grey fs.- fine grained matrix- 7-IO*/. fragments
- 2-l5mm, 3mm ove.- andesitic and quartzitic In composition
-~IV. light blue, translucent quartz eyes-trace pyrrhotite- chlorite alteration
- grey-brown ws., greenish-grey fs.- aphanitic matrix- 7-10V. amygdules
- white to beige colour- mainly quartz- Imm-Smm. 3mm ove.
- rusty spots, but no visible sulphides '- chlorite alteration in places ,
CLAIM I02540B
CLAIM 1025409
tf-
*2 POST CLM. 1025408
- tan coloured blocks and fragments- domlnantly quartzitic- lcm-lm, 40cm ave.- ~80V. of rock- some are flow banded
-medium grained matrix, but difficult to see
LEGEND
Grey Member (Onaping Formation)- Intermediate luff
Andesite - Intrusive
White Breccia Unit- sedimentary
SCALE l TO 125
S. MCKINLEY, JULY/90
MAI
NVI
LLE
LUM
BER
CO
MPA
NY
LIM
ITED
R.R.
#2,
Site
14,
Box
5CH
ELM
SFO
RD.
ONT
ARIO
POM
l LO
Phon
e 85
5-25
77
QT
Y.
C.O
.D.
l C
HA
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CH
AR
GE
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/Si
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(fi.
PR
ICE
W w TA
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IVE
D B
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TO
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0822
All
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and
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od
s M
UST
be
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ill
VALL
EY EAST
CLAI
M BLOCK
TRENCH GEOLOGY
NECK
(?
)
GO
-70%
xen
olith
*lig
ht g
rey
to b
eige
fg.
mat
rixm
ainl
y qu
artz
itic
xeno
llfhs
--
2-30
cm;
6cm
ove
.-
angu
lar
to r
ound
ed
poss
lWy
iphe
rulit
lc
mat
rix s
uppo
rted
- fin
e tu
ff w
ith 2
5-30
Y.
fragm
ents
- gr
ey-g
reen
mat
rix-
quar
tz a
nd a
ndes
ite f
rags
. :
- Im
m-I2
cm;
5mm
ave
.-
man
y ar
e ch
lorit
ized
-HV
. lig
ht b
lue
quar
tz e
yes
(0.5
mm
ove
.)-
trace
pyr
rhot
ite
- ta
n ws
.. gr
eeni
sh-g
rey
fs.
- up
to
lOVo
am
ygdu
les
:-
l-IO
mm
; 3m
m a
ve.
- al
l ap
pear
to
be q
uartz
-~3V
o lig
ht b
lue
trans
luce
nt q
uartz
eye
s-
up t
o 4m
m;
Hm
m o
ve.
- ro
ck h
as a
mor
e *c
haot
ic*
appe
aran
ce-
fragm
ents
diff
icul
t to
dis
tingu
ish
- ch
lorit
e is
mor
e di
sper
sed
- br
ecci
a do
min
ated
by
quar
tziti
c bl
ocks
and
fra
gmen
ts-
buff
colo
ured
on
wea
ther
ed s
urfa
ce-8
0V
. of
roc
k-
lcm
-m's
, 10
cm a
ve.
- an
gula
r lo
rou
nded
- ap
pear
to
be a
ligne
d-
a fe
w r
usty
spo
ts,
but
no v
isib
le s
ulph
ides
LEG
END
Gre
y M
embe
r (O
napi
ng F
orm
atio
n)-
Inte
rmed
iate
tuf
f
And
esite
- i
ntru
sive
Whi
te B
recc
ia U
nit
- se
dim
enta
ry
SCAL
E P
250
*2 P
OST
CL
M.
1025
408
10m
. M
CX
lML
EY
.T
OU
-*'
. "iO
..
MAI
NVI
LLE
LUM
BER
CO
MPA
NY
LIM
ITED
R.R
#2,
Site
14,
Box
5CH
ELM
SFO
RD,
ONT
ARIO
POM
1LO
Phon
e 85
5-25
77
MAI
NVI
LLE
LUM
BER
.CO
MPA
NY
LIM
ITED
R.R.
*2,
Site
14,
Box
5CH
ELM
SFO
RD,
ON
TAR
IO P
OM 1
LOPh
one
855-
2577
CU
ST
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NO
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0824
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ied
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AM
OU
NT
RE
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IVE
O B
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TA
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0823
All
cla
ims
a
nd
re
turn
ed
g
oo
ds
MU
ST
be a
cco
mp
an
ied
by t
his
bill
.
MAI
NVI
LLE
LUM
BER
CO
MPA
NY
LIM
ITED
R.R.
02,
Site
14,
Box
5CH
ELM
SFO
RD,
ONT
ARIO
POM
1LO
Phon
e 85
5-25
77
SO
LD B
Y
CA
SH
C
.OD
C
HA
HB
E
ON
AC
CT
MD
SE
.RE
TD
. P
AID
OU
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NP
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OU
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r—
All
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ims
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y
Q Q
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MU
ST
be a
cc
om
pa
nie
d b
y t
his
bill
.
SER
IES
010
VALLEY EAST CLAIM BLOCK
..., TRENCH GEOLOGY
QUARTZ VEIN
fluidal texture miong fragment*
ILTFg
buff lo dark brown wi. gr*4nlfh-grty fi. 20-25V* fragment)- l-20mm, 4mm ove.- quar t il t * end oodiill*- 5- 7V. chlorttt shordj Irocc pyrrholDt up to IV. Ironskjctnt light bhM ojuorli
LEGEND
ILTFg- Intermedia!* lapilli luff - Grey Member
(Onaping Formation)
SCALE
79m l 335'
• t POST CLM. IO2S408
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VALLEY EAST CLAIM BLOCK
ANDESITE
- In in, areenUh grty fi.- opaonUlc matrix- up lo l OY. quartz eyei/amygdule!- 5-9K quortilU nnolllhs up lo 0.5m - meet art l-IOcm
- aweare to Intrude WMtt Driccla Unit 4 U mekei up iti matrix
- tree* Cpy In q fracture
INFERRED CONTACT
M POST CLM. 1025409 2O6m i 100'
WHITE BRECCIA
- buff to Waek MI, white lo buff tf.- u* to 65V. quartzite Mock! and fragmenti
- km-m'i, 15cm avo.- anfular lo rounded- Mack* or* often flow-banaed
- fix le nedkjm grained malrU- iwuaMy ctail-tupparted
OUTUNE OF TRENCH
TRENCH GEOLOGY
podi of finer material (andeilte ?) - -5V. quartz fragmenli 13cm ave.)
fragmenti are more rounded (graded ?)
GRANOPHYRE
- pink lo grey-brown wi., plnklth-grey fi.- medium to coorie grained- 40-5OV. K-feldipar. 20-23V. quartz, up lo 30V. mafic
(probably hornblende)- quartz U often preienl ai llgtit blue eyei
. gradallonol contact- gradei from granophyre lo typical breccia over -5m- matrix of breccia here li granophyre with *50V. K-feld*par
LEGEND
Amygdaloidal Andesite- aphanitic intrusive
White Breccia Unit- ledimenlary
Granophyre (SIC)- phaneritic Intrusive
SCALE
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Ministry ofNorthern Developmentasd Mines
Ontario)uld
1 f J 9QQ7. -A —— ""' 411 l*SW0e 15 63.54*4 GARSON 90O (or
*- - Refer to Sections 76 and 77, the Mining Act for assessment work requirements and the reverse side of this form for table of information.
Mining Act Report of WorkName and Address of Recorded Holder
P" A l— Go'0 ^ ft. \ o Gr S 1— l fv) i T f ̂ CGT^-Pt-Ol^.^T^O '^o}
(P. O - ft O X *-f O f12 A t— Co'0 fi ft^i ^ G^-C" O f^T ̂ \(5.l o P O *v\ \ S O
Prospector's Licence No.
/^- -2-\ (*,H~I
Telephone No. 6=1 3 - *7 —7 f \ EVT.
^ ' t.6;3'oSummary of Distribution of Credits and Work Performance
Mining Division
Township or Area
.T Total Assessment Credits Claimed
Type of Work. Performed (Check one only)
Q Manual Work
. — . Shaft Sinking Drifting or other U Lateral Work
[~] Mechanical equipment
l^-rPower Stripping other than Manual [^(maximum credit allowed - 100 days
per claim)|~1 Diamond or other Core drilling
Q Core Specimens
Mining Claim
Prefix
•s•s-s^•5
-sss-5
5
Number
/ O 'Z.^'-i- O~7
1 O 2.5*4 O ?
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/o2.55^
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1Dates when work was performed FronrtJ'JLV |( ^ 1^0 | To: /\u(
Tot
3t . ; o , n *i o /|—————————— "T
All the work was performed on Mining Claim(s): Indicate no. of days performed on each claim. * (See note No. 1 on reverse side)
Mining Claim No. of Days Mining Claim No. of Days
Mining Claim J
S'/O'Z.^O?Mining Claim
//lil No. of Days Performed
S-*3r"^-?-"" ̂ 'y-T S?T*A| No. of Days Claimed Total No. of Days to be Claimed at a
Future Date ——
/Noways
9*4E2.
No. of Days
Mining Claim
5/oZS-VotMining Claim
No. of Days
No. of Days
jVfiing Claimr*Mining Claim
No. of Days
No. of Days
Mining Claim
Mining Claim
No. of Days
No. of Days
Required Information eg. type of equipment, Names, Addresses, etc. (See Table on reverse side) If space below is insufficient, attach schedules with required information and location sketches
-V-tJoir-k J r O "sk* oldl-e,/- l ka.c.lc U oe.
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E C O R D E D
AU6 l Q 1990
CBPlitlcation of Beneficial Interest * (See Note No. 2 on reverse side)l 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.
Dat /y.Certification Verifying Report of Work
1 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 or witnessed same during and/or after its completion and the annexed report is true.
work
Name and Address of Person Certifying *
' ' f If /f *Telephone No. Date ™n:m
For Office Use Only 7Work Assignments
\crsHcv (H 5SS 1CV?SH6
Received Stamp, . .., , , ,- ' - ' .
",y i768 (69/06)
PA r^- --f-
Winistry ofNorthern DevelopmentantMvlines
Ontario
Instructions- Please type or print.- For each type of work performed, a separate Report of Work should
be completed.- For Geo-technical work, use form no. 1362 "Report of Work
(Geological, Geophysical, Geochemical") and form no. S7B for Expenditures.
- Refer to Sections 76 and 77, the Mining Act for assessment work requirements and the reverse side of this form for table of information.
Mining Act Report of WorkName and Address of Recorded Holder
PA L. C. OAJ g. ft. l
Prospector's Licence No.
A- -z. i c,
P.O. 11-cooTelephone No.
69 3 - Z. 7 i 5-0Summary of Distribution of Credits and Work Performance
Mining Division•5 *-J 0*3.0 ^.V
Township or Area
Total Assessment Credits Claimed /A
^••1 uUyjAType of Work Performed (Check one only)
Q Manual Work.—.Shaft Sinking Drifting or other LJ Lateral Work
| | Mechanical equipment
fn. Power Stripping other than Ma 1/41 (maximum credit allowed - 100
per claim) | | Diamond or other Core drilling
Q] Core Specimens
V
nual days
Mining ClaimPrefix
5•5-5
5SS-5
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Dates when work was performed
From: TUL^ M , \"\^O To: A '•'Gr. l a { l ^"lO
All the work was performed on Mining Claim(s): Indicate no. of days performed on each claim. * (See note No. 1 on reverse side)
Mining Claim No. of Days Mining Claim No. of Days
^^fo0
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pS/137 •SWaiMining Claim
II/Wo. of Days
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Number
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Mining ClaimPrefix Number
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No. of Days
No. of Days
Work Days Cr.
Total No. of Days to be Claimed at a Future Date
yMining Claim
Mining Claim
No. of Days
No. of Days
Mining Claim
Mining Claim
No. of Days
No. of Days
Required Information eg. type of equipment, Names, Addresses, etc. (See Table on reverse side) If space below is insufficient, attach schedules with required information and location sketches
S -f V-!''* *v*
-f [rJork ' "5"^ ly M - 10 O
;v\i^o.
AJ -7 AVJ 2.
Certification of Beneficial Interest * (See Note No. 2 on reverse side)l 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.
Date it (Signature)
Certification Verifying Report of Workl hereby certify that l 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 its completion and the annexed report is true.Name and Address of Person Certifying
Telephone No.- Z-7G
For Office Use OnlyWork Assignments RECORD * J*
m i o 1^- ;
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if A Gr er 3 o
'Ministry ofNorthern Developmentarvd M ines
Ontario
Instructions- Please type or print.- For each type of work performed, a separate Report of Work should
be completed.- For Geo-technical work, use form no. 1362 "Report of Work
(Geological, Geophysical, Geochemical") and form no. 878 for Expenditures.
- Refer to Sections 76 and 77, the Mining Act for assessment work requirements and the reverse side of this form for table of information.
Mining Act Report of WorkName and Address of Recorded Holder
F^A I—C 0 *sj rfS^J O G: G" Ul (exProspector's Licence No./\- ~z-i c* "-f-Telephone No.
P. 0 . PAI OGr E7 o, l S O . -2.S50Summary of Distribution of Credits and Work Performance
Mining Division•Soo^Oft-v/
Township or AreaGrAfVSOAJ i J
Total Assessment Credits Claimed J k
J4-aei-~Ju*^.fJr4Type of Work Performed " (Check one only)
Q Manual Work
. — . Shaft Sinking Drifting or other LJ Lateral Work
l | Mechanical equipment
i—. Power Stripping other than Manual PQ (maximum credit allowed - 100 days
per claim) l | Diamond or other Core drilling
Q3 Core Specimens
Mining Claim
Prefix
*s-5
-s5*5
S•5
•5
•s-5
Number
f 01 ^ 1 2. G
/•^I'+IT.G
;ol4' 7. "7
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Prefix NumberWork
Days Gr.
l t IIDates when work was performed From: :Tui.-/ || ( i li o To: (HU&. iO , J0|"\0 ,
Total No. of Days Perf*rrrfedl j***- /4 Total No. of Days ClafjJed ^-/--e-o //u
Total No. of Days to be Claimed at a Future Date
Ait the work was performed on Mining Claim(s): Indicate no. of days performed on each claim. * (See note No. 1 on reverse side)
Mining Claim No. of Days Mining Claim No. of Days
Mining ClainV
^7f7?^*r4-j*Mining Claim
No. of Days
^iPONo. of Days
Mining Claim
Mining Claim
No. of Days
No. of Days
Mining Claim
Mining Claim
No. ol Days
No. of Days
Mining Claim
Mining Claim
No. of Days
No. of Days
Required Information eg. type of equipment, Names, Addresses, etc. (See Table on reverse side)If space below is insufficient, attach schedules with required information and location sketches
~~r C LJorf-k ' 0 -, V PC. o T *~ u* *- . r oioe.,r
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Certification of Beneficial Interest * (See Note No. 2 on reverse side) //f /}rf1 hereby certify that, at the time the work was performed, the claims covered in this report Date A of work were recorded in the current recorded holder's name or held under a beneficial interest /lby the current recorded holder. //^
Certification Verifying Report of Work V
HecordecmiSlder oKA^aot (Signature)/?.y^s ^ef—^'\ 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 its completion and the annexed report is true.Name and Address of Person Certifying
"^~7~o A f^-T Gt-inSSyi
For Office Use OnlyWork Assignments
1
r
OS , P.O. OQ K ^0 ; PAt-C
Telephone No. Date/^^ 1 - Z.-7 C- \ /-p.
^ E C 0 R H r; J *
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lO/OiSRiOaG-e- x ^f^~r//, Pf?^ 1 S 0
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Received Stamp . . jl 1 ' r: | ' : i - l : i '
i ; l
•. - -- " " '^'^
M- O
Ontario
Ministry ofNorthern Development'and.Mines
O o.*-tt
Instructions- Please type or print.- For each type of work performed, a separate Report ot Work should
be completed.- For Geo-technical work, use form no. 1362 "Report of Work
(Geological, Geophysical, Geochemical") and form no. 878 for Expenditures.
- Refer to Sections 76 and 77, the Mining Act for assessment work requirements and the reverse side of this form for table of information.
Mining Act Report of WorkName and Address of Recorded Holder
V— ~ A L-, d- o *~o t^ *3* \ O
P.O. (i D,X t-l o
&T e- i~ l ^ i
f^A i— C o /o i3 (i. i i
TE-*:
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* rffeXPc-O.on
0 rOT A fc 1 0 ( ^
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sot*1 /SO,
Prospector's Licence No.
A — :z. y fc ^~7Telephone No.
(o "l "3 — 2. 7 (^ l G"*t- ^ 6go
Summary of Distribution of Credits and Work PerformanceMining Division-Su 0 So c. V
Township or Area f— ^/\ ^ (P C" O L
Total Assessment Credits Claimed fln
Type of Work Performed f (Check one only)
G Manual Work
. — .Shaft Sinking Drifting or other LJ Lateral Work
l | Mechanical equipment
,-yPower Stripping other than Manual M (maximum credit allowed - 100 days
per claim)l | Diamond or other Core drilling
Q Core Specimens
Mining Claim
Prefix
-5
S5S
S-s•s
Number
/OZ54I5; o l Ss* 7 (o/ozs^nl 025^-1 Z
1 0 ZS 1-// 0!
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Number
r o/ '-f-i'-fSXo( ^,^k/o ; H1 /^"?/o/^/^g-i 014 J 4- 1
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Number
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, ;Dates when work was performed
From: 'J'uuiy (| ( /l^o To: XI u Gr. 'O
All the work was performed on Mining Claim(s): Indicate no. of days performed on each claim. * (See note No. 1 on reverse side)
Mining Claim No. of Days Mining Claim No. of Days
Total No. of Days PerforiheU Total 1
' ——— f*^"Mining Claim t N a. of Days Mining Claim No. o( C
-Mining Claim No. of Days Mining Claim No. of C
*/•Jo. of Days Claitftfd Total No. of Days to be Claimed at a
— jj^j H A F uture Date
'
ays Mining Claim No. of Days Mining Claim No. of Days
ays Mining Claim No. of Days Mining Claim No. of Days
Required Information eg. type of equipment, Names, Addresses, etc. (See Table on reverse side) If space below is insufficient, attach schedules with required information and location sketches
o- c{ozc-s~ 1 ko-c. k. U o e. j cxi^ol c*. ^"M^x. p'-c.SS'-A vr^. ^^"^fO .
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/lCertification of Beneficial Interest * (See Note No. 2 on reverse side)
1 hereby certify that, at the time the work was performed, the claims covered in this report Date /l of work were recorded in the current recorded holder's name or held under a beneficial interest II , by the current recorded holder. 'r^L ' ' i l
Certification Verifying Report of Work u
//f /T/7Recorded Mender or/Wgfant (Signature)
(7 IT1 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 its completion and the annexed report is true.Name and Address of Person Certifying
P.O. aox^-o ;P^ L CO^Telephone No. Date
For Office Use OnlyWork Assignments ^
R E C O R 0 F D
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