Ontario

' MinistryOf Report*5L ofw"'k•JJToWr/

w*The Min

Address of Recorded Holder4ioi5NEseie W83ee-ee4i4 ROLLO

j___y3. fAtvjL y^ u|J

010

//SS tSummary of Work Performance and Distribution of CreditsTotal Work Days O. claimed

for Performance of the following work. (Check one only)

Q Manual Work

Qshaft Sinking Drifting or other Lateral Work.

(^] Compressed Air, other Power driven or mechanical equip.

Power Stripping

j Diamond or other Core drilling

l Land Survey

All the work was performed on Mining Claim(s)

Required Information eg: type of Names, Addresses, etc. (See Table Below)

(

Xc'*S'4\fS ( / t e -

[ KTARiO GEOLOGICAL SURVEY ASSESSMENT FII.EG

F F: B H1984

RECEIVED i"'' " ": D -;: D

DEC l 1983

Date of Report Recorded (Signature)

Certification Verifying Report of Workl hereby certify that l have a personal and intimate knowledge of the facts tet forth In the Report of Work annexed hereto, having performed the work or witnessed tame during and/or after its completion and the annexed report it true.

AName and Postal Address of Person Certifying

/6V/^ sData Certified

Table of Information l Attachments Required by the Mining Recorder

Type of Work

Manual Work

Shaft Sinking, Drifting or other Lateral Work

Compressed air, other power driven or mechanical equip.

Power Stripping

Diamond or other core drilling

Land Survey

Specific information per type

Nil

Type of equipment

Type of equipment and amount expended. Note: Proof of actual cost must be submitted within 30 days of recording.

Signed core log showing; footege, diameter of core, number and angles of holes.

Name and address of Ontario land surveyor.

1 "' p ' -Other information (Common to 2 or more types)

Names and addresies of men who performed manual work /operated equipment, together with dates and hours of employment.

Names and addresses of owner or operator together with dates when drilling/strippingdone.

Nil

Attachments

Work Sketch: these are required to thow the location and extent of work In relation to the nearest claim post.

Work Sketch (as above) In duplicate

Nil

768 (81/3)

Ministry ofNatural/Resources

Report of Work

OntarioThe Mining Act

Instructions - Supply required data on a separate form for each type of work to be recorded (see table below).

- For Geo-technieal work ute form no. 1362 "Report of Work (Geological, Geophysical, Geochemical and Expenditures)".

lame *nd Hosral Address of Recorded Holder Prospector's Licence No.

Summary of Work Performance and Distribution of CreditsTotal Work Days Cr. claimed

for Performance of the following work. (Check one only)

Q Manual Work

riShaft Sinking Drifting or other Lateral Work.

Q] Compressed Air, other Power driven or mechanical equip.

Q}?ower Stripping

Diamond or other Core drilling

Land Survey

All the work was performed on Mining Claim(s):

Required Information eg: type of equipment, Names, Addresses, etc. (See Table Below)

POnCUPINE MINING DIVISION

DEC 1 5 1983 lA M' PlM '

F: r. o o R D E D

Date of Report Recorde Noldfr gef nature)

Certification Verifying Report of Work -/-xefl here1 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 tame during and/or after its completion and the annexed report is true.*

Name and Postal Address of Person Certifying

t ft A)te Certified r S

As-f?AiTable of Information l Attachments Required by the Mining Recorder

Type of Work

Manual Work

Shaft Sinking, Drifting or other Lateral Work

Compressed air, other power driven or mechanical equip.

Power Stripping

Diamond or other core drilling

Land Survey

Specific information per type

Nil

Type of equipment

Type of equipment and amount expended. Note: Proof of actual cost must be submitted within 30 days of recording.

Signed core log showing; footage, diameter of core, number and angles of holes.

Name and address of Ontario land surveyor.

Other information (Common to Z or more types)

Names and addresses of men who performed manual work /operated equipment, together with dates and hours of employment.

Names and addresses of owner or operator together with dates when drilling/strippingdone.

Nil

Attachments

Work Sketch: these are required to show the location and extent of work in relation to the nearest claim post.

Work Sketch (as above) in duplicate

Nil

768

Ministry df Natural ,/ Resources

Report of Work

_ OntarioThe Mining Act

Instructions - Supply required data on a separate form for each type of work to be recorded (see table below).

- For Geo-technical work use form no. 1362 "Report of Work (Geological, Geophysical, Geochemical and Expenditures)",

ametnd Postal Address of Recorded Holder Prospector's Licence No.

Summary of Work Performance and Distribution of CreditsTotal Work Days Cr. claimed

for Performance of the following work. (Check one only)

Q Manual Work

r")Shaft Sinking Drifting or other Lateral Work.

Q Compressed Air, other Power driven or mechanical equip.

Power Stripping

Diamond or other Core drilling

Land Survey

All the work was performed on Mining Claim(s):

Required Information eg: type of equipment, Names, Addresses, etc. (See Table Below)

PORCUPINE MINING DIVISION

[DECEIVEDEC 151983 V

P.M.

RECORDED

' D EC l h 1983

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 work or witnessed same during and/or after its completion and the annexed report Is true. -

Name and Postal Address of Person Cerjif y i'-T.

XDate Certified

Table of Information l Attachments Required by the Mining Recorder

Type of Work

Manual Work

Shaft Sinking, Drifting or other Lateral Work

Compressed air, other power driven or mechanical equip.

Power Stripping

Diamond or other core drilling

Lend Survey

Specific Information per type

Nil

Type of equipment

Type of equipment and amount expended. Note: Proof of actual cost must be submitted within 30 days of recording.

Signed core log showing; footage, diameter of core, number and angles of holes.

Name and address of Ontario land surveyor.

Other Information (Common to 2 or more types)

Names and addresses of men who performed manual work /operated equipment, together with dates and hours of employment.

Names and addresses of owner or operator together with dates when drilling/strippingdone.

Nil

Attachments

Work Sketch: these are required to show the location and extent of work In relation to the nearest claim post.

Work Sketch (as above) in duplicate

Nil

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