Fillable MINERAL TITLE PLAN INFORMATION FORM (A completed copy (BC Land Title & Survey)

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MINERAL TITLE PLAN INFORMATION FORM (A completed copy (BC Land Title & Survey)

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MINERAL TITLE PLAN INFORMATION FORM
(A completed copy of this form is to be submitted with any electronic mineral title plan submission)
LTSA File No.: EPC No:
Survey Plan Heading:
CONTACT INFORMATION
To: Surveyor General Services
Land Title and Survey Authority of BC
200 – 1321 Blanshard St
Victoria BC V8W 9J3
(250) 410-0600 Surveyor.General@ltsa.ca
Tenure Holder’s Office:
Contact:
Phone:
MEM Office File:
Contact:
Phone:
Survey Office File:
Contact:
Phone:
SURVEY TYPE
Indicate if this is the first legal survey of the mineral title or a subsequent survey of a mineral lease
LA Section 7 - Survey of mineral tenure not required by
the Chief Gold Commissioner
MTA Section 42 - Survey of the mineral claims going to
lease required by the Chief Gold Commissioner
Partial boundary survey Partial boundary survey
Full boundary survey Full boundary survey
Infrastructure survey
MTA Section 44 - Survey to reduce lease MTA Section 45 - Legal survey of placer claim or lease
going to lease of placer minerals
Partial boundary survey Partial boundary survey
Full boundary survey Full boundary survey
TENURE/SURVEY REQUEST DETAILS
MTA Tenure(s) Number(s): BCGS Map Sheet(s):
Land District:
Mining Division:
List Details:
(i.e. number of claims of units in the mineral title, lots, special circumstances, cross reference to adjacent survey files and type of
mineral extraction, etc.)
Indicate if the mineral claim has been reconfigured prior to survey -
IDENTIFY AFFECTING INTERESTS
Ministry of Energy and Mines
MTO Title Status
Clear Conflict - Description of Conflict:
Land within MEM No Staking and Conditional Reserves: Yes No Partially Nearby
Site #/Site Name/OIC or MO #/File ID #:
Land within Placer Designated Area: Yes No Partially Nearby
Site #/Site Name/OIC or MO #/File ID #:
Mineral/Coal/Placer Lot Status
Clear Conflict Nearby Description of Conflict:
IDENTIFYAFFECTING INTERESTS
Surveyed Parcels
Surveyor General Services Use Only
Survey(s) (if applicable, please list--attach separate sheet if necessary)
Yes No Attachment Land Titles
Title(s) (if applicable, please list)
Yes No Attachment
(attach separate sheet if necessary)
Land Act
, Section 75 cancellation of survey required/requested
Yes No Attachment
List request details (attach separate sheet if necessary):
Road(s) or Right(s) of Way
Land Act
, Section 103
(Roads surveyed, gazetted and others) Cancellation required/requested
Clear Conflict Attachment
Description of conflict (attach separate sheet if necessary):
Parks, Ecological Reserves, Conservancy Sites, Heritage Sites and
Protected Areas
Ministry notified if applicable:
Yes No
Adjacent or near to boundary
Yes No
Area Name (Federal, Provincial, Regional, Municipal):
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MINERAL TITLE PLAN INFORMATION FORM (A completed copy (BC Land Title & Survey)

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Completed 25 July 2021

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