BEFORE THE STATE ENGINEER OF THE STATE OF NEVADA
APPLICATION FOR EXTENSION OF TIME TO PREVENT A FORFEITURE FOR MINING AND MILLING
Name of person signing this form
who after being first duly sworn and answering to the best of his/her knowledge the following questions in compliance with the requirements as set forth in the Certificate of Claim:
3. Nevada Division of Water Resource's (NDWR) Owner(s) of Record on file in the office of the State Engineer:
b. If "No" on Question 4a is checked, on whose behalf is this extension being filed?
7. Give date when the last full beneficial use occurred?
9. Explain in detail the reason for non-use.
10. Describe the progress made during the past year as compared to previous years to resume beneficial use.
YOU WILL BE PROMPTED FOR A $120 FILING FEE PER YEAR REQUESTED IN THIS APPLICATION FOR EXTENSION OF TIME.
A SEPARATE APPLICATION MUST BE FILED FOR EACH CERTIFICATE OR CLAIM.