Last updated: 5/30/2006
Statement Of Mineral Claim
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Description
STATEMENT OF MINERAL CLAIM Document Number (TYPE OR PRINT CLEARLY IN BLACK INK) BY THIS INSTRUMENT, CLAIMANT(S), whose (name is) (names are): AND whose address is: Recording Area Name and Return Address Claims an interest in the minerals in the following described real estate in ___________________________________County, State of Wisconsin: Parcel Identification Number (PIN)Document No. _______________________________, Volume ________________ Page ______________ of the instrument recorded on(date) ________________________________________ created the interest in the minerals. Dated this ______________ day of __________________________, ___________ (Year). Signature_______________________________________________ Signature__________________________________________________ *______________________________________________________ *_________________________________________________________ Signature_______________________________________________ Signature__________________________________________________ *______________________________________________________ *_________________________________________________________ AUTHENTICATION or ACKNOWLEDGEMENT The above named person(s) personally came before me on (date)_______________________________________________Signature of notary or other person authorized to administer an oath (as per 706.06, 706.07) _______________________________________________State of Wisconsin, County of ____________________________________ Print or type name _____________________________________________Title_________________________________________________________ Date commission Expires________________________________________This instrument was drafted by: *Names of persons signing in any capacity must be typed or printed below their signature.NOTE: A Wisconsin Real Estate Transfer Return is required for instruments that convey real property.
