Government of Ontario: Mining and Lands Commissioner

Notice of Appeal

Under Subsection 112(3), Mining Act, R.S.O. 1990, c. M. 14

Personal information collected on this form is obtained under the authority of the Mining Act, R.S.O. 1990 c. M.14. This information will be used for correspondence. Questions about this collection should be addressed to the Mining and Lands Commissioner, P.O. Box 330, 24^th Floor, 700 Bay Street, Toronto, Ontario M5G 1Z6.

Appellant

Telephone
( )

Street No. Unit/Suite/Apt
Street Name
City/Town or Village
Province/State Postal Code /Zip Code

Appellant's Address for Service in Ontario:
Street No. Unit/Suite/Apt
Street Name
City/Town or Village

Province Postal Code

Appellant's Lawyer or Agent (if any)

Telephone
( )

Street No. Unit/Suite/Apt
Street Name
City/Town/Village
Province Postal Code

Specify the mining division of the mining recorded being appealed:

Specify the matter being appealed (identify the property)

Complete if applicable
Date the Decision was Recorded (yyyy/mm/dd)
Date the act was done or refused to be done (yyyy/mm/dd)
State briefly the reasons for the appeal

Signature

Date (yyyy/mm/dd)

"Mining Lands Website: http://www.mndm.gov.on.ca/mndm/mines/lands/default_e.asp"

0252E (2022/11)

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