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Name: Cripple Creek & Victor Gold Mining Company <br />Mailing Address: P.O. Box 191, Victor, CO 80860 <br />Phone: Office: (719) 689 -4055 <br />Fax: (719) 689 -4056 <br />Home: <br />Email: tcomer @anglogoldashantina.com <br />(10 -08 -2009) <br />® WRITTEN, NOTARIZED, AUTHORIZATION AND CONSENT FROM ALL PROPERTY OWNERS FOR <br />AUTHORIZED AGENT TO ACT ON THEIR BEHALF <br />NOTE: ALL CORRESPONDENCE REGARDING THIS APPLICATION WILL BE ADDRESSED TO THE <br />AUTHORIZED AGENT /REPRESENTATIVE UNLESS OTHERWISE REQUESTED. <br />Name: Mike Lust, Foresight West Land Surveying Inc. <br />Mailing Address: 12424 East Weaver Place, Suite 100, Englewood, CO 80111 <br />Phone: Office: (303) 504 -4440 <br />Home: <br />Fax: (303) 759 -0400 Email <br />Name: Please refer to individual reports included as Appendices to the DRMS application <br />Mailing Address: address and contact information as above <br />Phone: Office: <br />Fax: <br />Legal Description of Property: <br />❑ If Subdivision, name: <br />Lot Block <br />Home: <br />Email: <br />See Attachment 3 for complete Legal Description <br />Filing Tract <br />❑ If Metes and Bounds: Section Township Range OR Attach a legal <br />description and survey depicting the property boundary. <br />❑ If Mining Claim(s), include name(s) and Mineral Survey Number(s): <br />Street Address: <br />Assessor's Tax Parcel Identification No(s) (PID): Please see Attachment A <br />NOTE: IF LESS THAN THE ENTIRE PROPERTY IS THE SUBJECT OF THIS APPLICATION, ALSO <br />ATTACH A LEGAL DESCRIPTION OF THAT PORTION AFFECTED. <br />Page 2 of 4 <br />