Said claim is situated in the vicinity of _______________________ or in the

________________________________________________ Mining District, County of

San Bernardino, State of California.

The date of this location is the __________ day of _________________, 19___

2. The undersigned locators are citizens of the United States, or have

declared their intention to become such.

3. The said locator___ do____ hereby locate and claim ___________________

(Not to exceed 1500)

linear feet of this vein or lode, together with surface ground extending

___________________ feet in width on each side of the middle of said vein