2014-12-17_REVISION - M1994114

• Permit No: M1994114
• IBM Index Class Name: Revision
• Doc Date: 12/17/2014
• Doc Name: Conversion Application
• From: Kagan and Son, LLC
• To: DRMS
• Type & Sequence: CN1
• Email Name: TOD
• Media Type: D
• Archive: No

Receipt#: 22706 Page 1 of 1
USDA United States Department of Agriculture
RECEIPT FOR SERVICE
On December 08, 2014, James Sperry of the SILVER CLIFF SERVICE CENTER
discussed the following services and benefits provided by the USDA Natural Resources
Conservation Service (NRCS) with Rebbecca Kagan (Kagan and Son, LLC) of 555 Ernest
Ave., Westcliffe, CO 81252. The discussion took place via Office Visit.
Servicing Office Address: 5 HERMIT LN, SILVER CLIFF, CO 81252-0389
Requested:
Other (Describe Below)
Receipt of Conversion Mining permit copy for state of Colorado permit number M19-94-
114 to support reclamation plan.
Resolution Provided:
Other (Describe Below)
Received completed application for file.
Receipt #: 22706
The U.S. Department of Agriculture(USDA)prohibits discrimination against its customers, employees, and
applicants for employment on the bases of race,color,national origin,age,disability, sex, gender identity,
religion, reprisal, and where applicable,political beliefs, marital status, familial or parental status, sexual
orientation, or all or part of an individual's income is derived from any public assistance program, or
protected genetic information in employment or in any program or activity conducted or funded by the
Department. (Not all prohibited bases will apply to all programs and/or employment activities.)
If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program
Discrimination Complaint Form, found online at http://www.ascr.usda. ovg /complaint filing_cust.html, or at
any USDA office, or call [phone] to request the form. You may also write a letter containing all of
the information requested in the form. Send your completed complaint form or letter to us by mail at U.S.
Department of Agriculture,Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington,
D.C. 20250-9410,by fax[phone] or email at program.intakegusda.gov.
Individuals who are deaf,hard of hearing or have speech disabilities and you wish to file either an EEO or
program complaint please contact USDA through the Federal Relay Service at(800) 877-8339 or(800) 845-
6136 (in Spanish). Persons with disabilities,who wish to file a program complaint,please see information
above on how to contact us by mail directly or by email. If you require alternative means of communication
for program information(e.g., Braille, large print, audiotape, etc.)please contact USDA's TARGET Center at
[phone](voice and TDD).
https:Hrfs.sc.egov.usda.gov/rfs/ReceiptEntry.aspx 12/8/2014