Form 3860-2 Certificate of Title on Mining Claims

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UNITED STATES
DEPARTMENT OF THE INTERIOR
BUREAU OF LAND MANAGEMENT

Form 3860-2
(March 2013)

FORM APPROVED
OMB NO. 1004-0025
Expires: March 31, 2016
Mineral Entry Serial Number

CERTIFICATE OF TITLE ON MINING CLAIMS

An individual

a corporation, hereby

certifies that an examination of the instruments shown by the indices in the office of the Recorder of the County
of

, State of

, discloses that the title to the mining

claim hereinafter described that was acquired by the locators of said claim by the filing of said claim is at the date
hereof vested in

Subject to:

(1) Paramount title of the United States of America.

(2) Any taxes or assessments that may be a lien.

(3) The inadequacy of any evidence of labor that may appear of record.

(4) Adverse rights which may exist by reason of any encroachment of other mining claims onto the claim

hereinafter described or of any overlapping of the boundaries of said claim onto other claims.

The mining claim above referred to is that certain claim situate in the
County of

mining district,

, State of

, more particularly

described as follows (see instructions):

This certificate is issued and accepted upon the understanding that the liability assumed hereby must not
exceed $100.

Seal

(Individual or Firm Name)

(Address)

(Date)

By

(Signature)

Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 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.
(Instructions on page 2)

INSTRUCTIONS
1. Description of mining claims may be incorporated by reference to and attachment of a
certified copy of certificate of location.
2. A certificate, when executed by a corporation, must:
a. bear the corporate seal;
b. indicate where corporation was organized; and
c. indicate authority to do business in the state in which the land is located.
NOTICES
THE PRIVACY ACT and the regulation in 43 CFR 2.48(d) provide that you be furnished the
following information in connection with information required by this application.
AUTHORITY: 30 U.S.C. 22, 29, 39, 43 CFR 3862.1-3.
PRINCIPAL PURPOSE: The information will be used to complete and verify the chain of title
in mining claims.
ROUTINE USES: (1) The adjudication of the applicant’s rights to the land or resources; (2)
documentation for public information in support of notations made on land status records for the
management, disposal, and use of public lands and resources; (3) transfer to appropriate Federal
agencies when concurrence is required prior to granting a right in public lands or resources; and
(4) either specific information from the record or the complete record itself will be transferred to
appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or
regulatory investigations or prosecutions.
EFFECT OF NOT PROVIDING INFORMATION: A Certificate of Title will not be issued.
THE PAPERWORK REDUCTION ACT requires us to inform you that:
The BLM collects this information to properly provide the requested service. The information
provided will be used to determine the level of service required. Submission of the requested
information is necessary to obtain or retain a benefit. You do not have to respond to this or any
other Federal agency-sponsored information collection unless it displays a valid OMB control
number.
BURDEN HOURS STATEMENT: Public reporting burden for this form is estimated to
average 4 hours per response, including the time for reviewing instructions, gathering and
maintaining data, and completing and reviewing the form. You may submit comments regarding
the burden estimate or any other aspect of this form to: U.S. Department of the Interior, Bureau
of Land Management (1004-0025), Bureau Information Collection Clearance Officer (WO-630),
1849 C St., N.W., Room 2134LM, Washington, D.C. 20240.

_____________________________________________________________________________________________________________________                                         

                                                                                                                                                                                                (Form 3860-2, page 2)