Notice of Survey

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Form 14

Protected A

Privacy Act Statement

The information you provide on this form is collected by Aboriginal Affairs and Northern Development Canada under the authority of the Northwest Territories and Nunavut Mining Regulations for the purpose of depositing a notice of survey. The information may be made available for public inspection, as prescribed by the Regulations, and will be handled in accordance with the provisions of the Privacy Act   . Individuals have the right to the protection of unauthorized disclosure of and access to their personal information that is under the control of a federal government institution. Instructions for obtaining your personal information are provided in  Info Source  , a copy of which is available at major public and academic libraries or on line.

Note: One claim per form unless a perimeter survey of multiple claims.

• NWT
• Nunavut

• Yes
• Not Applicable

Take notice that a survey has been made of the above mineral claim(s) under instructions from the Surveyor General, and that at the termination of 30 days following the completion of posting of this notice, the said survey may be approved and recorded, unless in the meantime it is protested, as provided in Section 56 of the Northwest Territories and Nunavut Mining Regulations.