Maintenance Fee Payment For Lode Claims, Mill Sites, And Tunnel Sites Form printable pdf download

Maintenance Fee Payment For Lode Claims, Mill Sites, And Tunnel Sites Form

SUGGESTED FORMAT

Use of this format is suggested but not required

UNITED STATES

DEPARTMENT OF THE INTERIOR

BUREAU OF LAND MANAGEMENT

MAINTENANCE FEE PAYMENT

FOR LODE CLAIMS, MILL SITES, AND TUNNEL SITES

Remitter Name:

Mailing Address:

City, State, Zip:

Check here if this is a change of address

No. of claims/sites:

x $155 per claim/site

Total due to BLM $

1. The maintenance fee may be paid by cash, check, money order, Bureau of Land Management (BLM) Declining

Deposit Account, or credit card (VISA, American Express, Discover, or MasterCard). Payments must be remitted

to the BLM State Office where your claim or site is recorded and received on or before September 1. If the

payment is mailed, the envelope must be postmarked by a bona fide delivery service on or before September 1

and received at the proper BLM State office within 15 calendar days after the due date. Payments may also be

made by telephone using a credit card. A complete listing of BLM State Offices with their addresses and phone

numbers can be found at

2. The maintenance fee for the following claim(s) applies to assessment year _______.

CLAIM/SITE NAME

BLM SERIAL NO.

10.

11.

12.

13.

Page 1

Maintenance Fee Payment For Lode Claims, Mill Sites, And Tunnel Sites Form