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fo 10,4005, <br />Application Checklist <br />Application Form: Complete the form located on page 5. <br />0— Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />an afety. <br />Performance Warranty: Complete the form located on page 11. <br />fir✓ A nOMI- <br />financial Warranty: Submit the appropriate Financial Warranties or conditional <br />replacement Financial Warranties using the forms posted on the Division's website <br />(avai ble online at http: / /mining. state .co.us /Mineral %20Forms.htm). <br />5061wrn LCAW –. <br />(te 4D ► Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />t,#4N g#Kg&( righ , obtain the documentation described above, and submit to the Division. <br />1 Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. <br />RECEIVED <br />FEB 12 2015 <br />Division of RedamaWn, <br />Mining & Safety <br />-4- <br />