H.—ls

13

SCHEDULE E. Memorial for Registration of the Claim, to be presented in Duplicate to the Registrar, who shall sign and return one copy thereof. We, the undersigned, hereby make application to Register the Claim in accordance with the particulars herein contained, together with the shares or interests therein as set opposite our names.

Schedule F.

SCHEDULE G. Memorial of Encumbrance. To be presented in duplicate, and one copy signed and returned by Registrar. No.

Datei us day of , 13 1 ,attl iour o: I o o h3 ist 111 5 I . 91, 6 o IS 2 So J OS -s 1 94 « *pg ■■§ s ii o o -a M * S I 1 6 =1 c8 O 1) O -5 a g §.*?§ m 2 • - £ a g EbS'S 5,3 (5 2 o -s a § S>is 8 iegisterei the day of ,187 at the LOUT of Begistrar.

Paet I. Paet II. Issignment — No. Date of Eegistration— Memo, of Assignment. ?articulart — Assignor— Assignee— Date of assignment— Nature of Property assigned— Interest therein Assigned— Eeference to Folio of Eegister— Fees Eeceived— Mining Begistrar's Office, 187 . I have this day registered a document exhibited to me by , purporting to be an assignment of of which the particulars are as follows:— Name of Assignor— Name of Assignee— Date of Instrument of Assignment— Nature of Property Assigned— Interest Assigned therein— Eeference to Folio of Eegister— Fees Eeceived— iignature of Assignor or Agent ~) presenting Assignment. ) Mining Eegistrar. Original documents to be exhibited, and ir his agent. ifter being marked by Eegistrar to be returned to assignee

•escription of Claim, or other authorized Holding. Interest intended to be affected by such Encumbrance. Name of Owner of Interest. Nature of Encumbrance. Date of Instrument. Remarks. Date of Eegisi •ation. (Signature o: Grantor of Encumb; ■anee.) (Signature of Registrar.) (Signature oi Grantee of Encumb] •ance.)