Form 3830-3 Notice of Intent to Locate a Lode or Placer Mining Claim

Form 3830-3
(January 2004)

UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT
NOTICE OF INTENT TO LOCATE A LODE OR PLACER MINING CLAIM(S)
AND/OR A TUNNEL SITE(S)
ON LANDS PATENTED UNDER THE STOCK RAISING HOMESTEAD ACT OF 1916,
AS AMENDED BY THE ACT OF APRIL 16,1993

FORM APPROVED
OMB NO. 1004-0114
Expires: December 31, 2006

Homestead Patent Number

TO ALL WHOM IT MAY CONCERN:
This notice is filed under Public Law 103-23 of April 16, 1993 (107 Stat. 60), entitled "An Act to amend the Stock Raising Homestead Act
to resolve certain problems regarding subsurface estates, and for other purposes." The undersigned places all interested parties on notice
that, within 90 days of filing this notice with the BLM and after 30 days from the date of receipt of a copy of this notice by the surface
owner(s) of record, the undersigned intends to enter the lands described below to explore for a discovery of a valuable mineral deposit(s)
and to locate a mining claim(s), and/or tunnel site(s), as provided under the mining laws of the United States (30 U.S.C. 22, et seq.). The
area covered by this notice and all other notices filed by the undersigned and any affiliate(s) of the the undersigned, and which continue to
be in effect on the date of this filing does not exceed 6,400 acres of such land in any one State and 1,280 acres of such land for a single
entity. This notice, for a single State and surface ownership, covers the following lands:
1/4

SECTION

in
Total acres under this notice
Name and mailing address of affected surface owner(s):

TOWNSHIP

RANGE

MERIDIAN

County, State of

.

.
Name and mailing address of person filing this notice:

Brief description of the proposed casual use exploration activities (i.e., activities that cause no more than a minimal disturbance to the
surface resources and do not involve the use of mechanized earth-moving equipment, explosives, the construction of access roads, drill
pads, or the use of toxic or hazardous materials):

Date(s) on which such activities will take place:
(Continued on page 2)

Attached is a map showing the existing access routes proposed to be used for casual use exploration purposes, primary areas of interest, and
types of activities to be conducted.
The above described activities will be managed by:
Name
Mailing Address

Phone Number (include area code)

Dated this

day of

, 19

.

Signature of:

(Person)

(Affiliate)

RECORDER'S STAMP

NOTICE/BURDEN HOURS STATEMENT
The Privacy Act of 1974 and the regulations in 43 CFR 2.48(d) provide that you be furnished the following information.
AUTHORITY: 30 U.S.C. 22 et seq. and43 U.S.C. 299 (b); 43 CFR 3814 and 3830.
PRINCIPLE PURPOSE: This information is to be used to verify that the mining claimant has complied with the pre-location notice of intent to locate
requirements of Public Law 103-23, now codified at 43 U.S.C. 299 (b), and is therefore qualified to locate and record mining claims on lands patented
under the Stockraising Homestead Act of 1916, as amended.
ROUTINE USE: (1) Verification that the mining claimant has properly noticed the surface owner of the land previously patented under the Stockraising
Homestead Act of 1916, as amended by the Act of April 16, 1993 (43 U.S.C. 299[b]). (2) Disclosure may be made to appropriate Federal agencies when
location is made within the agency's geographic area of responsibility. (3) Information from the record and/or the record will be transferred to the
appropriate Federal, State, or local agency, or a member of the public in response to a specific request for pertinent information. (4) Information may also
be provided to the Department of Justice or in a proceeding before a court or adjudicative body; or to Federal, State, local or foreign agencies when needed
for enforcement of civil or criminal codes or applicable regulations concerning title rights upon the public land.
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of this information is required by the Act of April 16, 1993 (Public Law 103-23; 43
U.S.C. 299 [b]) and 43 CFR 3814 and 3830 for those mining claimants who desire to locate mining claims upon lands previously patented under the
Stockraising Homestead Act of 1916, as amended. Failure to supply the information required in this form to show the mining claimant's compliance with
the terms of the above statute will result in the rejection and/or cancellation of any mining claims located upon such lands by the mining claimant.
The Paperwork Reduction Act of 1995 requires us to tell you that: This information is being collected to allow the BLM to determine if you are qualified
to locate mining claims upon lands previously patented under the Stockraising Homestead Act of 1916, as amended, as required by the Act of April 16,
1993 (Public Law 103-23) and the implementing regulations at 43 CFR 3814 and 3830. A response to this request is required in accordance with the
statute (Public Law 103-23) to retain your benefit.
BLM would like you to know that you do not have to respond to this, or any other, Federal agency-sponsored information collection unless it displays a
currently valid OMB control number.
Public reporting burden for this form is estimated to average 8 minutes per response, including the time for reviewing instructions, gathering and
maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U.S.
Department of the Interior, Bureau of Land Management (1004-0114), Bureau Information Collection Clearance Officer (WO-630), Mail Stop 401 LS,
1849 C St., N.W., Washington, D.C. 20240.

(Form 3830-3, page 2)