STATE OF OREGON, County of ) ss. I, , being first duly sworn ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Owner’s name and current mailing address' in the designated field.
3. Fill in the 'NAME OF CLAIM' section with the specific unpatented mining claim you are declaring.
4. Complete the 'BLM RECORDS FOR LOCATION SERIAL NO.' by providing the necessary serial number related to your claim.
5. Indicate whether federal maintenance fee requirements have been met by checking the appropriate box and providing details about labor performed or improvements made.
6. If applicable, provide information regarding any maintenance fee waiver qualifications, including dates of labor and who performed it.
7. Finally, ensure to sign and date the affidavit before a notary public, confirming all information is accurate.

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