Inactive Dredge Declaration Form

Select Dredge Number:

Owner Details

Owner’s Name *

ID# or TIN*

Confirm ID

Mining Details

Mining District

Claim or Permit Number

Claim or Permit Holder

Location

Declaration Details

Reason

Other (please specify)

I hereby declare that the aforementioned dredge is currently inactive/parked and not in operation as of

I understand that this declaration does not exempt the operation from inspection or reporting requirements should circumstances change. I also agree to inform GGMC in writing prior to resuming operations.