PDF format, 20 kb - Ministère de l`Énergie et des Ressources

Mining rights transfer application
SECTION 1 :
IDENTIFICATION OF BUYER (if more than one buyer, see reverse)
Company registration no
Name of company
Client no
COMPANY
or
Name
First name
Client no
Date of birth
INDIVIDUAL
Address (number, street, R.R. or P.O. box)
Province
App.
Country
Area code Fax
Postal Code
City, town or municipality
Area code Telephone (home)
Area code Telephone (office) Ext.
E-mail address
SECTION 2 – CORRESPONDENCE ADDRESS (If different)
Company registration no
Name of company
Client no
COMPANY
or
Name
First name
Client no
Date of birth
INDIVIDUAL
Address (number, street, R.R. or P.O. box)
Province
App.
Country
Area code Fax
Postal Code
City, town or municipality
Area code Telephone (home)
Area code Telephone (office) Ext.
E-mail address
SECTION 3 – LIST OF MINING TITLES AND PERCENTAGE TRANSFERED
% OF HIS RIGHTS IN TITLES MENTIONED HEREUNDER.
THE GRANTOR TRANSFERS
TITLE No
TITLE No
TITLE No
TITLE No
Note : If the space is insufficient, print another page or enclose an annex.
SECTION 4 – REGISTRATION FEES
The transfer of mining rights must be submitted along with the registration fees which amount to 18,22 $ per title, up to a maximum of
1480,16 $ per deed. The payment must be made out to the « Ministre des Finances du Québec ».
Amount to enclose : number of titles
$
X 18,22 $ =
Method of payment :
Account balance of the intervening party #___________
Cheque payable to the Ministre des Finances
Money order
Application won’t be processed before the payment is completed. Credit card information should not be forwarded on this form.
SECTION 5 – SIGNATURE OF PARTIES AND RESOLUTION (if more than one grantor or buyers, see reverse)
IF THE GRANTOR IS A COMPANY, RESOLUTION FROM THE BOARD OF DIRECTORS MUST COMPULSORILY BE ATTACHED TO
THE PRESENT APPLICATION.
NOTE : IF THERE ARE MORE THAN ONE BUYER, ENTER THE PERCENTAGE TRANSFERRED TO EACH OF THEM.
GRANTOR (in block letters)
BUYER (In block letters)
%
COMPANY
COMPANY
NAME
NAME
FIRST NAME
FIRST NAME
X
Signature
X
Date
Signature
Date
FOR DEPARTMENTAL USE ONLY
Registration seal
Ministère de l’Énergie et des Ressources naturelles
This form can be
Sent to the following mailing address:
Ministère de l’Énergie et des Ressources naturelles
Service de la gestion des droits miniers
5700, 4e Avenue Ouest, local C-320
Québec (Québec) G1H 6R1
or
Emailed to: [email protected]
or
Faxed to: 418 643-9297
Service de la gestion des droits miniers
Request no:
Reception date:
2016-12-14 – Page 1 de 2
GRANTOR (in block letters)
BUYER (In block letters)
COMPANY
COMPANY
NAME
NAME
FIRST NAME
FIRST NAME
%
ADDRESS
X
Signature
X
Date
Signature
GRANTOR (in block letters)
BUYER (In block letters)
COMPANY
COMPANY
NAME
NAME
FIRST NAME
FIRST NAME
Date
%
ADDRESS
X
Signature
X
Date
Signature
GRANTOR (in block letters)
BUYER (In block letters)
COMPANY
COMPANY
NAME
NAME
FIRST NAME
FIRST NAME
Date
%
ADDRESS
X
Signature
X
Date
Signature
Date
NOTE: IF SPACES ARE INSUFFICIENT, PLEASE, USE THIS PAGE AS A COPY.
NOTE: IF MORE THAN ONE BUYER, THE BUYER OF “SECTION 1” WILL BE THE RESPONSIBLE UNLESS THE GRANTOR
TRANSFERS ONLY A PART OF HIS RIGHTS.
Ministère de l’Énergie et des Ressources naturelles
Service de la gestion des droits miniers
2016-12-14– Page 2 de 2