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1 42L06SW GZOWSKI 010 w* W (k f /I/O w* k V*"*; RECEIVED f -ftr f r AUG GEOSCIENCE ASSESSMENT OFFICE ' /c "* f or r e * * fo 3 ru ve ke't or
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7 Ministry of Northern Development and Mines Declaration of Assessment Work Performed on Mining Land Mining Act, Subsection 65(2) and 66(3), R.S.O Transaction Number (office use) \MAAl Assessment Files Research Imaging 42L06SW GZOWSKI 900 Instructions: - For work performed on Crown Lands before recording a claim, use l - Please type or print in ink. ty of subsections 65(2nwd 66(3) offhe l^lng Att LlWfer section 8 of the l to review the 'assessrrfwn worfr'and'iibrrespond with the mining land holder ng Recorder, Ministry of Norther OFFICE- S!!'-"1 ^ v"i v R E C E - 1. Recorded holderfs) (Attach a list if necessary) Na up. imi Client Number 2. Type of work performed: Check ( ^ ) and report on only ONE, of the following groups for this declaration. D Work Type /^j^ Geotechnical: prospecting, surveys, assays and work under section 18 (regs) Global Positioning System Data (if available) V Sc c IS ' \jj Cll c l 6!' Day Month j Year Day Township/Area M or G-Plan Number f~ _ f fr"? (S* *v r*" 'Physical: drilling, stripping, trenching and associated assays Month Year i. f Commodity Office Use Total S Value of ^ -.. Work Claimed ^ ff Oo^ NTS Reference Mining Division -r2 Resident Geologist District IJlLUYlA 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. Rehabilitation ^y^^ 3. Person or companies who prepared the technical report (Attach a list if necessary) Name Address co, Mi Telephone Number Fax Number Name Telephone Number Address Fax Number Name TeiephoneNum^ Address Fax Number Certification by Recorded Holder or Agent LO- GEOSCIENCE ASSESSMENT OfFICE :, 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. SignatuM of Recorde^ Holder or Agent
8 5. Work to be recorded and distributed. Work can only be assigned to claims that are contiguous (adjoining) t the mining land where work was performed, at the time work was performed. A map showing the contiguous link must accompany this form... G0//A 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. Number of Claim Units. For other mining land, list hectares. Value of work performed on this claim or other mining land. 6032/ Value of work applied to this claim. Value of work assigned to other mining claims. Bank. Value of work to be distributed at a future date. eg TB ha S26, 825 N/A S24,000 12,825 eg , eg /3o2c3^ 2 /O S 8, 892 # '3&Z. f S 4,000 3^ S4.892 O w. - fcqrde MIC 2 6 KM. - 1 Di\- 15 Column Totals 1 1 3&1L.*0 w., do hereby certify that the above work credits are eligible under 2^32, ** ^r -^ (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. Signa of Re Holder or, ntaut in Writing 6. Instructions for cutting back credits that are not approved. frfr m? Some of the credits claimed in this declaration may be cut back. Please check ( ^ ) in the boxes below to show how you wish to prioritize the deletion of credits: 0 1. Credits are to be cut back from the Bank first, followed by option 2 or 3 or 4 as indicated. Q 2. Credits are to be cut back starting with the claims listed last, working backwards; or D 3. Credits are to be cut back equally over all claims listed in this declaration; or Q 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 Only Received Stamp Deemed Approved Date Date Notification Sent Date Approved Total Value of Credit Approved Approved for Recording by Mining Recorder (Signature)
9 Ontario Ministry of Northern Development and Mines Statement of Costs for Assessment Credit Transaction Number (office use) Personal information collected on this form is obtained under the authority of subsection ( 5(1) of trtwssegsmentworyregulation 6/96. Under section 8 of the Mining Act, the information is a public record. This information will be usi the mining land holder. Questions about this collection should be directed to the Chief Mi ning Recorder, Ministry ( F Mines, 6th Floor, 933 Ramsey Lake Road, Sudbury, Ontario, P3E 6B5. Work Type Pfy^fCety SfVfflp''^ \ ' ' cj Units of Work Depending on the type of work, list the number of hours/days worked, metres of drilling, kilo metres of grid line, number of samples, etc. /^/flu/x Old***) fy,***.rlrxllklk f No l ROvrwe ft*c"wffew *t PN o nwiw*sblhj8w RECEIVED ^ AUG Co* p" uknlt ^rftisffiummiat tim, tirta**0 Associated Costs (e.g. supplies, mobilization and demobilization). R ECORDEC AUG \ Transpt Food and Lodging Costs 3 to ^ca ftf t**jks*t tj X /TV^y 5 ^ l 1 SYO, Total Value of Assessment Work ^yot tro V'lSM'** Calculations of Filing Discounts: 1. Work filed within two years of performance is claimed at 100"Vfo of the above Total Value of Assessment Work. 2. If work is filed after two years and up to five years after performance, it can only be claimed at 5007o of the Total Value of Assessment Work. If this situation applies to your claims, use the calculation below: TOTAL VALUE OF ASSESSMENT WORK x 0.50 = Total 3 value of worked claimed. Note: - Work older than 5 years is not eligible for credit. - A recorded holder may be required to verify expenditures claimed in this statement of costs within 45 days of a request for verification and/or correction/clarification. If verification and/or correctior /rlarifjrationjs jiotjjade,, the Minister may reject all or part of the assessment work submitted. RECEIVED Certification verifying costs: AUG GEOSCIENCE ASSESSMENT Uu. ', do hereby certify, that the amounts hown arecbslcaccurate a; may (please print full narfiej reasonably be determined and the costs were incurred while conducting assessment work on the lands indicated on the accompanying Declaration of Work form as to make this certification. (recorded holder, agent, or state company position with signing authority) l am authorized 0212 (02/96) Signature Date y tiuau'rf7s i j r /f f f
10 Ministry of Northern Development and Mines Ministers du Developpement du Nord et des Mines Ontario Geoscience Assessment Office 933 Ramsey Lake Road October 22, th Floor Sudbury, Ontario GERALD MILKS P3E 6B5 70 NEESOMADINA AVENUE BOX 233 Telephone: (888) HORNEPAYNE, ONTARIO Fax: (877) POM-1ZO Visit our website at: Dear Sir or Madam: Submission Number: Status Subject: Transaction Number(s): W Approval We have reviewed your Assessment Work submission with the above noted Transaction Number(s). The attached summary page(s) indicate the results of the review. WE RECOMMEND YOU READ THIS SUMMARY FOR THE DETAILS PERTAINING TO YOUR ASSESSMENT WORK. If the status for a transaction is a 45 Day Notice, the summary will outline the reasons for the notice, and any steps you can take to remedy deficiencies. The 90-day deemed approval provision, subsection 6(7) of the Assessment Work Regulation, will no longer be in effect for assessment work which has received a 45 Day Notice. Allowable changes to your credit distribution can be made by contacting the Geoscience Assessment Office within this 45 Day period, otherwise assessment credit will be cut back and distributed as outlined in Section #6 of the Declaration of Assessment work form. Please note any revisions must be submitted in DUPLICATE to the Geoscience Assessment Office, by theresponse date on the summary. If you have any questions regarding this correspondence, please contact Lucille Jerome by at lucille.jerome@ndm.gov.on.ca or by telephone at (705) Yours sincerely, ORIGINAL SIGNED BY Blair Kite Supervisor, Geoscience Assessment Office Mining Lands Section Correspondence ID: Copy for: Assessment Library
11 Work Report Assessment Results Submission Number: Date Correspondence Sent: October 22, 1999 Assessor:Lucille Jerome Transaction Number First Claim Number Township(s) 1 Area(s) Status Approval Date W GZOWSKI Approval October 22, 1999 Section: 10 Physical PSTRIP Although this work has been approved, in all future assessment work submissions of physical work, additional information will be required. Detail maps of the workings must be provided with physical work submissions. In this case, for example, because there is old work and newer work performed, a detail map should distinguish between the old and new work in order to more accurately reflect the work done. If the above requirements are not met the Minister may reduce or reject assessment work credit for a submission. Correspondence to: Resident Geologist Thunder Bay, ON Assessment Files Library Sudbury, ON Recorded Holder(s) and/or Agent(s): GERALD MILKS HORNEPAYNE, ONTARIO CHARLES WILLIAM PAUL HORNEPAYNE, ONT Page: 1 Correspondence ID: 14257
12 NOTES WILLET LAKE G-156 Deedsr FROM HTS MR - MiN NO RIGHTS Lake DEEDS LAKE G-29 HIGHWAY AND ROUTE No. OTHER ROADS TRAILS LEGEND SURVEYED LINES TOWNSHIPS, BASE LINES, ETC. LOTS, MINING CLAIMS, PARCELS, ETC UNSURVEYED LINES LOT LINES PARCEL BOUNDARY MINING CLAIMS ETC. RAILWAY AND RIGHT OF WAY UTILITY LINES NON-PERENNIAL STREAM FLOODING OR FLOODING RIGHTS SU BDI VISION OR COM POSITE PL AN RESERVATIONS ORIGINAL SHORELINE MARSH OR MUSKEG MINES TRAVERSE MONUMENT DISPOSITION OF CROWN LANDS TYPE OF DOCUMENT PATENT SURFACE S. MINING RIGHTS 11, SURFACE RIGHTS ONLY ", MINING RIGHTS ONLY LEASE, SURFACE ft MINING RIGHTS, SURFACE RIGHTS ONLY 11, MINING RIGHTS ONLY LICENCE OF OCCUPATION ORDER-IN-COUNCIL RESERVATION CANCELLED SAND 4 GRAVEL LAND USE PERMITS FOR COMMERCIAL TOURISM, OUTPOST CAMPS y l NOTE MINING RIGHTS IN PARCELS PATENTED PRIOR TO MAY VESTED IN ORIGINAL PATENT6E BY THE PUBLIC LANDS ACT, R.S.O. 1970, CHAP. 380, SEC. 63, 8UB8EC SCALE: 1 INCH - 40 CHAINS in lhal qpptari on thl* map ha bim oomplbd lowest amt ooouraey f* not auarentevd. Thoi* irtnlno olclim ihotdd eorwult wfth the Mining Mry of Northern D*vtlopmcirf gn4 MInti for rmatlon an Iht itahu of Ih* landt in own htrcon. in-., r- -r WO THE INFORMATICSHhAl APPEARS MAP HAS BEEN COMPILED FROM VARIOUS SOURCES. AND ACCURACY IS NOT GUARANTEED OCT llkhmfc TD CiTAifF SHOULD CONSULT WITH THE iv.lnimg TRY OF NORTHERN DEVcLCFMEW l, FOR ADDITIONAL INFORMATION ON VHt STATUS OF THE LANDS SHOWN HSrREON GZOWSKI ~ r ' l I2I MN H. ADMINISTRATIVE DISTRICT NIPIGON MINI*-? THU^OER LAtfD t ltles/ i^hw DIVISION THUNDER BAY l- -Jlv iisirvtir A Nai. -l M. ces Ontario n service sines G L06SW
13 WNSHIP GZOWSKI R ADMINISTRATIVE DISTRICT NIPIGON ING DIVISION THUNDER BAv D TITLES/ REGISTRY DIVISION THUNDER BAY Ministryof Natural ReSOU'CeS ano ln service since Land Management Branch ter G- 182 Q LU ^^ in.ii.i ULi O LU o: CD m CO exs CD ^ 2 LU O) 03 LU Wo LUU. 00 LU 0 ^ w i 0 1 LU ' en, r 11 11~ i HI?- ("r* 1! u i -J i SCALE: l INCH - 40 CHAINS FEET O 1OOO 2OOO 400O 6000 O METRES 2OO tooo M KM) 2OOC (7 KM 42L06SW GZOWSKI 210 LEGEND MINING CLAIMS ETC RAILWAY AND RIGHT OF WAY
14 W N ifttitf~ RECEIVED. GEOSCIENCE ASSESSMENT OFFICE O O Sea! \* 42L06SW GZOWSKI 220
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19 7 ^ -',.in-'-"*''* " / "' v- k'''j -v*j.,v'.'..-i-' - -- '" ^' ' ^.!"; v.i - j"3t'';". ~*- " SCALE: 11NCH -40 CHAINS V-jfc. -.J f DATE OF ISSUE ! I2324I8, l in OJ cf /N fw i^i APR O PROVINCIAL RECORDING ' -OFFICE-SUDBURY TOWMIHIP GZOWSKI M.N.R. AOMINISmATIVE DISTRICT NIPIGON j y. --J.,,.. MIHI^ OIVIS'JN THUhCER BAY LAiO.ITIES/ ft^mltry aivisiom THUNDER BAY I232535, [ J ; i f.-j_.4 i ^ W nistryof *- Nai. J 3CSOU C8S Ontario n service sines K f*4 - : G-182 M ^ ^ ^ j ^" 7*? J 6M i ^,1 ^4 YM -n - G-173 "o.oi 4M Z T^C 2M "t.7. '-*y 42L06SW GZOWSKI 270 Mini
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