28
Position
Approximate area
Boundaries N.
S.
E.
W.
22
DESCRIPTION OF PROSPECTING AREA.
Dated this
day of
19......
Fee paid $
For and on behalf of the
Governor in Council.
Clerk of Councils,
Registered at
.this day of
19...
No:
District of
Land Officer.
1 J
23
29
SKETCH PLAN.
(Sketch plan to be drawn here indicating approximately north point, scale, posi- tion and area of the land.)