Form 3860-2
(March 2019)
OMB NO. 1004-0025
Expires: March 31, 2022
Mineral Entry Serial Number
An individual a corporation, hereby
certies that an examination of the instruments shown by the indices in the ofce 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 ling 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 mining district,
County of , State of , more particularly
described as follows (see instructions):
This certicate is issued and accepted upon the understanding that the liability assumed hereby must not
exceed $100.
(Individual or Firm Name)
(Instructions on page 2)
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, ctitious, or fraudulent statements or representations as to any matter within its jurisdiction.
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1. Description of mining claims may be incorporated by reference to and attachment of a certied copy of certicate of location.
2. A certicate, 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.
The Privacy Act of 1974 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 3861.1.
PRINCIPLE PURPOSE: The information is to be used to complete the chain of title to 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. (4)(5) Information from the record and/or the record 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 Certicate of Title will not be issued.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to properly provide the requested service.
Information will be used to determine the level of service required.
Response to this request is required to obtain a benet.
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.
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. Direct comments regarding the burden estimate or any other aspect of this form to U.S.
Department of the Interior, Bureau of Land Management (1004-0025), Bureau Information Collection Clearance
Ofcer (WO-630), 1849 C Street, N.W., Mail Stop 401LS, Washington, D.C. 20240.
(Form 3860-2, page 2)