The Lands in Question Are Not Being Used for Mining Purposes

/ Ministry of Northern Development
Mines and Forestry / Application for Exemptionfrom MiningLand Tax
Mining Act, Subsection 189 (1.1)
Personal information collected on this form is obtained under the authority of subsection 189 (1.1) 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 Registered Owner(s) and/or the named Contact Person in that regard. Questions about this collection should be directed to the Provincial Tax Coordinator, Ministry of Northern Development, Mines and Forestry, 933 Ramsey Lake Road, SudburyON P3E6B5. Telephone 1 888 415-9845.
For more information on Mining Land Tax exemption, please visit the Ministry’s website: (Mines & Minerals Division – Mineral Development & Lands Branch – Mining Lands Section – Policies). Or, call the Dispositions Office 705670-5847 / toll free at 1 888 415-9845 ext. 5847.
Section 1 ─ Legal Description of Property
Township / Lot No. / Concession No. / Mining Claim No./ Location / PIN and/or Roll No.
(if available) / Sub-account No.
Application must include proof of ownership [a copy of parcel register / Parcel Identification Number (PIN)] obtained from the appropriate Land Registry Office, showing the current registered owners of the land.Your application is incomplete unless your account is paid in full.
Section 2 ─ Contact Person Information
Last Name / First Name
Unit No. / Street No. / Street Name / Rural Route / PO Box
City/Town / Province / Postal Code / Telephone No.
Mining Land Tax Account No. / Sub-account No.
Are you aware of any mine hazards or other rehabilitation concerns relating to the land? Yes No
If yes please describe:
Section 3 ─ Registered Owners (all must be listed and must sign)
I/We, the registered owner(s) of the property(s) in question, here by my/our signature certify that:

• The lands in question are not being used for mining purposes,
• I/We do not intend to permit future use for mining purposes,
• The person identified in section 2 is the authorized contact person for the registered owners for purposes of this application, and
• All information provided within this application is true and correct to the best of my/our knowledge.

Full Name of Registered Owner (first and last name) / Signature / Date (yyyy/mm/dd)
Full Name of Registered Owner (first and last name) / Signature / Date (yyyy/mm/dd)
Full Name of Registered Owner (first and last name) / Signature / Date (yyyy/mm/dd)
Full Name of Registered Owner (first and last name) / Signature / Date (yyyy/mm/dd)
Full Name of Registered Owner (first and last name) / Signature / Date (yyyy/mm/dd)
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)
It is an offence under the Mining Act to knowingly make a false statement on this form.
Office use only

0298E (2011/01) Page 1 of 1