______________________, being first duly sworn according to law, depose and
say_______: That_____h_____ citizen___ of the United States over the age of
twenty-one years; that _____ h_____ owner_____ by pre-emption, location and
occupation of the foregoing tunnel site, the said tunnel being prosecuted
for the development of lodes belonging to said affiant_______, also for the
discovery of other lodes; affiant___ further say ______ that ____ h_______
ha___ expended in actual work and improvements on said tunnel not less than
__________________________________________________________________ Dollars,
and that said tunnel has already been run the distance of _________________
___________ feet, and that it is bona fide ___ h______ intention to