Form DMM-U-5 "Uranium Exploration Hole Report of Plugging Completion Affidavit" - Virginia

What Is Form DMM-U-5?

This is a legal form that was released by the Virginia Department of Mines, Minerals and Energy - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2016;
  • The latest edition provided by the Virginia Department of Mines, Minerals and Energy;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DMM-U-5 by clicking the link below or browse more documents and templates provided by the Virginia Department of Mines, Minerals and Energy.

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Download Form DMM-U-5 "Uranium Exploration Hole Report of Plugging Completion Affidavit" - Virginia

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DIVISION OF MINERAL MINING
900 NATURAL RESOURCES DRIVE, STE. 400
CHARLOTTESVILLE, VIRGINIA 22903
(434) 951-6310
URANIUM EXPLORATION HOLE REPORT OF PLUGGING COMPLETION
AFFIDAVIT
STATE OF ________________________________________________________________________________
COUNTY OF__________________________________, TO WIT:___________________________________
(2 WITNESSES REQUIRED)
NAME_____________________________________________________________________________________
NAME_____________________________________________________________________________________
being first duly sworn, depose and say that:
They are experienced in the plugging of exploration holes and participated in the plugging which is
the subject of this affidavit on the hole referenced below:
Operator’s Hole Identification:__________________________________________________________________
Exploration Permit Number:____________________________________________________________________
Date(s) of Plugging:___________________________________________________________________________
Hole Collar Coordinates: X__________________ Y__________________ Elevation_____________________
VA State Plane Coordinate Zone: North _____ South _____
Depth of Hole:_______________________________________________________________________________
Hole Diameter:_______________________________________________________________________________
Hole Type (Core, DHH, Rotary, etc.):_____________________________________________________________
DMM-U-5
Rev. 04/16
Page 1 of 2
DIVISION OF MINERAL MINING
900 NATURAL RESOURCES DRIVE, STE. 400
CHARLOTTESVILLE, VIRGINIA 22903
(434) 951-6310
URANIUM EXPLORATION HOLE REPORT OF PLUGGING COMPLETION
AFFIDAVIT
STATE OF ________________________________________________________________________________
COUNTY OF__________________________________, TO WIT:___________________________________
(2 WITNESSES REQUIRED)
NAME_____________________________________________________________________________________
NAME_____________________________________________________________________________________
being first duly sworn, depose and say that:
They are experienced in the plugging of exploration holes and participated in the plugging which is
the subject of this affidavit on the hole referenced below:
Operator’s Hole Identification:__________________________________________________________________
Exploration Permit Number:____________________________________________________________________
Date(s) of Plugging:___________________________________________________________________________
Hole Collar Coordinates: X__________________ Y__________________ Elevation_____________________
VA State Plane Coordinate Zone: North _____ South _____
Depth of Hole:_______________________________________________________________________________
Hole Diameter:_______________________________________________________________________________
Hole Type (Core, DHH, Rotary, etc.):_____________________________________________________________
DMM-U-5
Rev. 04/16
Page 1 of 2
AFFIDAVIT
Details of Plugging in accordance with VA Code Sections 45.1-277(1) or (4):
Note: Plugging Schematic must be attached
Note: Details on all materials left in the hole (including junk) must be provided
NOTARIZATION -
Subscribed and sworn/affirmed to before me by ___________________________________, this
_______day of _________________, 20___, in the City/County of __________________________.
My Commission expires:_____________________________, 20_____.
Notary Public: ____________________________________________
(Affix Seal)
DMM-U-5
Rev. 04/16
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