2014-10-06_REVISION - M2012052

• Permit No: M2012052
• IBM Index Class Name: Revision
• Doc Date: 10/6/2014
• Doc Name: Transfer of Approved Mineral Application and Succession of Permit Applicant.
• From: CC&V
• To: DRMS
• Type & Sequence: SO1
• Email Name: TC1
• Email Name: TAK
• Media Type: D
• Archive: No

-2-
This form has beery approved by rite Mined Land.Reclamation Board parstrani to sections 34-32-119,C.R.S.,of the
Mined Lanni Reclamation Act art)34-32.5.119,C..83�,of lite Colorado Land Reclamation Act for the Extraction of
Construction Materials. Any alteration or modification oftltis form shall result lu volding any pernift Issued on the
altered or mod�fled fotnt and subject the operator to cease and desist orders and civil penaltiesfor operating tpithout a
permit pursuant to sections 34-32-123,C.R X,of the Mined Lund Reclamation Act and 34 32.5-123, C:R.S.,of the
Colorado Land Reclarnatlon Act far the L'xtraction ofConstruedon Materials.
Appli cant and Successor hereby request the State to consent to she assignment of the approved Perm it Applicati on
to recognize the SLK:CCSSor as the approved Applicant under the pem)itting process.
Providence Minim,LLC Upple Creek&Victor G dd Mining Company{"CCAV"}
Name of Permit pplicant nexf�.Ucc sear/jp��oarst
n9 io f+
By By
Signature of Offic Si 1tU c of ffiicer
Vi
Title of Officer Title of'Officer
NOTARY FOR PERMIT APPLICANT
s
STATE OF
COUINrl'Y OF_
The fore oing instrument was acknowledged before me this day ofL �rJ'' , `�� ,by
Av917Ge) kl as _ I"1t'fifG"1 i 'if� of
Rcali fence m"Inc LLC. .
NOTARY PUBUC: NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20144OM71
MY COMMISS1014 EXNRES FEBUARY 1%201111 My Commission expires:
NOTARY FOR SUCCESSOR APPLICANT
STATE OF Ctit Ciy�c, c )
COUNTY OF
'Fhe foregain l instrument was acknowledged before this / / day of /ep 1 /''b� ��1�`,by
yV�i yn� � GrnGe ��o! as V�u Per f of n9joCoo1 �SLIu/r L �o/a11
NOTARY PIMLiC i
My Commission expires: //A I o-01 7-
_".,;. rye;