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0319dS -c-9 3� <br />Application Checklist <br />[A Application Form: Complete the form located on page 5. <br />[� Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />q Performance Warranty: Complete the form located on page 11. <br />Financial Warranty: Submit the appropriate Financial Warranties or conditional <br />replacement Financial Warranties using the forms posted on the Division's website <br />(available online at http: / /mining. state .co.us /Mineral %20Forms.htm). <br />G f �'�'� 15 Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />rights, obtain the documentation described above, and submit to the Division. <br />s/ C kAq ® Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. . 0 —Pi � <br />RECEIVED <br />AUG 15 2014 <br />Division of Reclamation, <br />Mining & Safety <br />-4- <br />