SUMMARY OF WORK PERFORMED€¦ · ^^ g, c/ A, o?"-/ 0 iT/^f j)yS6/-! ji^37 n ^86 M,5iM 0^ ^ ^ *to/^...
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1
\ -^7-
itario Ministry ofNorthern Developmentand Mines
Declaration of Assessment Work Performed on Mining LandMining Act, Subsection 65(2) and 66(3), R.S.O. 1990
Assessment Files Research Imaging
Personal information collected on this form Is obtained under the authority of subsections 65(2) and 66(3) of the Mining Act. Under section 8 of the Mining Act, the information is a pi -. -.. -^ ~,rrespond with the mining land holder. Questions about this collection 933 Ramsey Lake Road, Sudbur
Instructions: - For work - Please ty t
42A01NE0244 W9680.00602 MORRISETTE
Jevelopment and Mines, 6th Floor,
900m 0240.
1. Recorded holder(s) (Attach a list if necessary)Name
MrClient Number
Address
12^Telephone Number
^705-)Fax Number
Name Client Number
Address Telephone Number
Fax Number
2. Type of work performed: Check ( ** ) and report on only ONE of the following groups for this declaration.
D Geotechnical: prospecting, surveys, assays and work under section 18 (regs)
Physical: drilling, stripping, trenching and associated assays [ | Rehabilitation
Work Type PJft^vtovOD Dn 1
Oates Work c .^ /-i,.-. Performed From 1^ i UC^f i
Day l Month |Global Positioning System Data (if available)
I.-AJ- 6q
199(0 TO U .A/cu, /9?fcYew Day | Month | Yaar
Township/Area
/no&ziserre T&tfM or G-Plan Number
Office UseCommodity
Total S Value of r Work Claimed 3 ^ ^
NTS Reference
Mining Division L f\s~.jlf /\ /a /exResident Geologist Q\J, -i t p
Please remember to: - obtain a work permit from the Ministry of Natural Resources as required;- provide proper notice to surface rights holders before starting work;- complete and attach a Statement of Costs, form 0212;- provide a map showing contiguous mining lands that are linked for assigning work;- include two copies of your technical report.
3. Person or companies who prepared the technical report (Attach a list if necessary)Name Telephone Number
Address Fax Number
30Name Telephone Number
Address Fax N umber
Name Telephone Number
Address Fax N umber
4. Certification by Recorded Holder or Agent
Hr- Arnoldl, rV- Hrflo\C)( Hi&nNfrfc._____ , do hereby certify that l have personal knowledge of the facts set(Print Name) -forth in this Declaration of Assessment Work having caused the work to be performed or witnessed the same during or after its completion and, to the best of my knowledge, the annexed report is true.Signature of Recorded Holder or Agen
0241 (02/99)
5. Work to be recorded and distributed. Work can only be assigned to claims that are contiguous the mining land where work was performed, at the time work was performed. A map showing the must accompany this form.
Mining Claim Number. Or if work was done on other eligible mining land, show In this column the location number Indicated on the claim map.
eg
eg
eg
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
TB 7827
1234567
1234568
| 0cm:?4
/i-Woz.\\Xb5®(o
n*fc5 8"?|Zo57;^I20S-7I9IZc?S-7z.oi^s-jr^jr
Number of Claim Units. For other mining land, list ectares.
16 ha
12
2
l
l
H4331\
Column Totals
Value of work performed on this claim or other mining land.
\
S26, 825
0
S 8, 892
3347J
33fft3.
Value of work applied to this claim.
lij N/A
S24,000
S 4,000
qc?o ""Hoc ^i boo '\(eOO 'l z oo ^32oo ^3^oo ^loo*'
I^HDO
Value of work assigned to other mining claims.
1 h , i: 1 1 : ' 1
S24,000
0
0
\Z-000
\2,OOO
^^ *Bank. Value of v^ to be distributed at a future date.
: ' II' i.••mi——— i -— — — —S2,825
0
S4,892
Z'093.
Z1Q33.
, do hereby certify that the above work credits are eligible under(Print Full Name)subsection 7 (1) of the Assessment Work Regulation 6/96 for assignment to contiguous claims or for application to the claim where the work was done.Signature of Recorded Holder or Agent Authorized in Writin
6. Instructions for cutting back credits that are not approved.
Some of the credits claimed in this declaration may be cut back. Please check ( ^ ) i n the boxes below to show how you wish to prioritize the deletion of credits:
SI 1. Credits are to be cut back from the Bank first, followed by option 2 or 3 or 4 as indicated.D 2. Credits are to be cut back starting with the claims listed last, working backwards; orn 3. Credits are to be cut back equally over all claims listed in this declaration; orD 4. Credits are to be cut back as prioritized on the attached appendix or as follows (describe):
Note: If you have not indicated how your credits are to be deleted, credits will be cut back from the Bank first, followed by option number 2 if necessary.
For Office Use OnlyReceived Stamp
02-11 (02/96)
Deemed Approved Date
Date Approved
fi
Date Notification Sent
Total Value of Credit Approved
and MinesO C 3 f
CO'
for Assessment Credit
f l Enation collactad on trill form la obtained undar tha authority of aubaecllon 6(1) ol the Aeeeaameni Work Regulation 6/06. UnderX tha Mining Ad. tha Information la a public record. TWa Information wM b* weed lo review Hw assessment work and corraapond with g o siQ land holder. Ouesltona about this collection should be directed to the Chlel Mining Recorder. Ministry ol Northern Development and y. 6th Floor. 933 Ramsay Lake Road. Sudbury. Ontario, P3E 6BS.
Work TypeUnlit of Work
Depending on the type ol work, lit! tha number ol hours/days worked, metres ol drilling, kilo metres ol grid Una. number ol samples, etc.
MoR
|Zt port ( .cx
Associated Costs (e.g. supplies, mobilization nnd demobilization).
Transportation Costs
Pood and Lodging Costa
.4? 7 X
Cost Per Unit
Total Value of Assessment Work
Total Cost
Calciilnllons ol Filing rj
filed wilhin Iv.u ycms ol poilotmanco is claimed at 1000Xo of the ahove Total Value of Assessment Work. 2 II woik Is lilod alter two yenrs and up to five years after performance, it can only be claimed at BOW ol the Tolnl Viiliie of Assessment Work. If this situation applies to your claims, uso Iho calculation bolow:IOIAI. VALUE OF ASSESSMENT WOI1K x 0.50 ^ Total S value ol worked claimod.
Note:- Work older than 5 years is not eligible lor ciodit.- A recorded holder mny be roqulred to votify expenditures claimed In this statement of costs within 45 days of a request tor verification and/or correclion/claiificallon. II verification nnd/or coirection/claiifiration is not made, the Minister may reject all or pail of tho assossmont work submitted.
Certification verifying costs:
__ ___ . do hereby certify, that the amounts shown are as accurate as mayl. ———___(please print full name)
reasonably be determined and the costs were incurred while conducting assessment work on the lands indicated on
the accompanying Declaration of Work form as TC;Cordi -e,tX. koVcX'C-r'_________ l am authorized; (record td holder, egent. or elite company potHton with signing minority)l ! l l li {L i ,t' i Wake this certificationir r i - ' 11 ' - l li
o? i? (Or "fi
,x
. REFERENCESAREAS WITHDRAWN FROM DISPOSITION
M.R.O. - MINING RIGHTS ONLY
S. R. O. -SURFACE RIGHTS ONLY
M.-f S. - MINING AND ', "t-ACE RIGHTS
Description
r r t, . ' **
Date Difpotmon F ilel
' ' '-9 f, H ftM R ! 160/05
J. iet'ion 36/00 - '.w * 56,'i W R O iSO ?05
SAND and GRAVEL
GRAVEL FILE 4612.;
THE INFORMATION THAT APPEARS ON THIS MAP HAS BEEN COMPILED FROM VARIOUS SOURCES, AND ACCURACY IS NOT GUARANTEED. THOSE WISHING TO STAJKE MIN ING CLAIMS SHOULD CON SULT WITH THE l MINING RECORDER, MINISTRY OF NORTHERN DEVELOP MENT AND MINES, FOR AD DITIONAL INFORMATION ON THE STATUS OF THE LANDS SHOWN HgREON.
NOTES j——~~~~~ ' ! 'Surface rights on Mining Claim L 10772 'emporarilyu/lth/lrntun Pila: d^l^Ci lwithdrawn. File :
Mining Claims outlined thus r- - . ore subject lo' rights and privileges granted by Mining Court Order — April 1,1946. File'. 19697.
NOTICE OF FORESTRY ACTIV TYTHIS TOWNSHIP l AREA FALLS WITHIN THE ———
l
TIMISKAMING MANAGEMENT UNIT ______.AND MAY BC SUBJECT TO FORESTRY OPERATIONS. THE MNR UNIT FORESTER FOR THIS AREA CkN BE CONTACTED AT: P.O. BOX 129
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COPY OF THIS MYLAR ARCHIVED MAY.04/92
ARCHIVED MAY 31, 1994ARCHIVED MAY 29/96
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TRAILS
JNSURVt t b J , H r
L0 r i INESPAflCE L BC)i,NfiAR vM IN 'NO : l AiM 1- *- T*.
U T l L i T ' ; i N E SNON PERENNIAL b !R[AVFLOODING O H r , iO!-i\r. " -,M^-;SUBDIVISION OR COMPOSE r P. ANRESERVATIONSORIGINAL SHORF LINEMARSH OR MUSKEGMINESTFIAVERSE MONUMENT
DISPOSITION OF CROWN LANDS
SYMBOL
!E -r 0
a e
Q Or H
B
a
TYPE OF DOCUMENT
PATENT SURf-At'.fr g, MIMNG Mi
SURFACE RIGHTS ONi Y
. MINING RIGHTS ONL vLEASE S URFACE 4 MINING MIGHTS
11 , S URFACE RIGHTS ONLYMINING RIGHTS ONL r
LICENCE OF OCCUPATION ORDER IN COUNCIL RESERVATION CANCEL LED SAND A GRAVEL
NOTE M INING RIGHTS IN "AH c t. S" A tN-t' " o M- MA'IB'3 vtS'F! . N M", iNA PA'tS'ff H' '"f e' B.LAUDS *i ' "S "V'n MAP igo St fi l b BS t i
L.O.or
oc
SCALE 1 INCH - 40 CHAINS
i- 1- F -O 1000 .'OOO 4OOO 8000
O 200 METRES
i 000 ?000'l * M
TOWNSHIP
MORRISETTEMN.R ADMINISTRATIVE DISTRICT
KIRKLAND LAKEMINING DIVISION
LARDER LAKELAND TITLES/ REGISTRY DIVISION
TIMISKAMING
Ministryof LandNatural M anagement Resources
Ontario
" I!l JANUARY 1985 Numfeir
CIRCUL/CTEO FEB. 26. I99O G-3217
BM-l-tfc
LEG W D
- SO PT
SO IOO f -r.
42A01NE0244 W9660.00602 MORRISETTE210
CROSS SecrtoM
DR ILLHOL.E.
: Alow.
REVISED