Government of Ontario: Ministry of Northern Development Mines and Forestry

Mineral Development & Lands Branch

Application for an Order Withdrawing Crown Mining Rights in Northern Ontario
Mining Act, Subsection 35.1(8)

Personal information collected on this form is obtained under the authority of subsections 35.1(8) and 178.2(1) of the Mining Act. This information will be used for the purposes of processing the application and to communicate with the Surface Rights Owner(s) and/or the named Contact Person in that regard. Questions about this collection should be directed to a Provincial Mining Recorder, Ministry of Northern Development, Mines and Forestry, 3rd Floor, 933 Ramsey Lake Road, Sudbury, Ontario P3E 6B5. Telephone 1 888 415-9845.

Section 1 ─ Description

Geographic Township/ Municipality/ District//County

Size of area to be withdrawn (if known)

Legal Description of property to be Withdrawn (detailed legal description of the land including lot, concession, or parts on a plan of survey, PIN)

Current and/or Planned Use of the Surface Rights (please give full details)

Section 2 ─Contact Person Information

Last Name
First Name

Unit No.
Street No.
Street Name
Rural Route
PO Box
City/Town
Province
Postal Code

Applicant Telephone No.
Applicant Fax No.
Applicant Email

Section 3 ─Surface Rights Owners (all must be listed and must sign)

I/We confirm by our signature(s) that:

I am/we are the registered owner(s) of the surface rights described in this application for withdrawal of the mining rights;
I/We support such order being issued.
The person identified in section 2 is the authorized contact person for the surface rights owners for purposes of this application and
All information provided with this application is true and correct to the best of my/our knowledge.

Full Name of Surface Rights Owner (first and last name)

Date (yyyy/mm/dd)

Signature

If the owner is a Corporation, print the signing officer’s name and position.

Last Name
First Name
Position
I have authority to bind the corporation.

Signature

Date (yyyy/mm/dd)

NOTE: Surface Rights Owner is defined in the Mining Act as an owner in fee simple of the land, as shown in the appropriate land registry office, who does not own the mining rights for the land.
Application to include the following:

a plan of survey and/or claim map highlighting the area to be withdrawn
Proof of ownership of the surface rights obtained from the Land Registry Office showing the current owners of the property [a parcel register/Parcel Identification Number (PIN)]

It is an offence under the Mining Act to knowingly make a false statement on this form.