by law together with ________________ feet on the ________________ side and
________________ feet on the ________________ side of the middle of said
vein at the surface, so far as can be determined from present developments;
and all veins, lodes, ledges, or deposits and surface ground within the
lines of said claim ________________ feet running ________________ from
center of discovery ________________ and ________________ feet running
________________ from center of discovery ________________, said discovery
________________ being situated upon said lode, vein, ledge or deposit, and
within the lines of said claim in _______________________________________
Mining District, County of ________________ and State of ________________