STATE OF COLORADO
<br />DIVISION *OF RECLAMATION, MINING AND SAFETY
<br />Department of Natural Resources
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<br />1313 Sherman St., Room 215
<br />Denver, Colorado 80203
<br />Phone: (303) 866 -3567
<br />FAX: (303) 832 -8106
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<br />January 2, 2015
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<br />Independence Pass, Permit M- 1984 -103, Annual Fee Invoice and Report Request
<br />COLORADO
<br />D I V IS I ON OF
<br />RECLAMATION
<br />MINING
<br />SAFETY
<br />John W. Hickenlooper
<br />Governor
<br />Mike King
<br />Executive Director
<br />Virginia Brannon
<br />Director
<br />PLEASE READ CAREFULLY — ACTION REQUIRED
<br />Please attach your COMPLETED written Annual Report and Annual Report Map to this form
<br />Under the terms of your NOI or Reclamation Permit and Colorado Statutes, you must submit Annual Fees and
<br />Annual Reports (including a map). You must pay the Annual Fee and submit an Annual Report each year until
<br />reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for
<br />LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was inactive.
<br />The Annual Report and Fee requirement will be considered submitted when we have received the following
<br />components:
<br />1. APPROPRIATE ANNUAL FEE
<br />2. COMPLETED ANNUAL REPORT
<br />3. ASSOCIATED MAP as required by rule
<br />If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety (the
<br />"Division ") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If
<br />the permit is released before the anniversary date, then by Statute, it is not necessary to pay an Annual Fee or submit
<br />an Annual Report for that year.
<br />Division records indicate the $323.00 fee is due for the following:
<br />Permit: M -1984 -103
<br />Operation Name: Independence Pass
<br />Anniversary Date: February 1, 2015
<br />Total Fee Due: $323.00 (Due on or before your Anniversary Date)
<br />Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY ORDER made payable to: Division
<br />of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver, CO 80203. If your records indicate
<br />these documents and fees have already been submitted, please notify the Division.
<br />If you have additional comments and /or information that should be provided to the Division, please provide it below
<br />or attach it to this form along with your written report and map. Annual Report instructions are enclosed. If you
<br />have any questions, please feel free to contact Michelle Ramirez (303) 866 -3567 ext 8114. Thank you for your
<br />cooperation in this matter.
<br />IF THE ANNUAL FEE SUBMITTALS ARE NOT RECEIVED ON OR BEFORE YOUR ANNIVERSARY
<br />DATE, THE ENFORCEMENT PROCESS WILL BE AUTOMATICALLY INIATIED. ENFORCMENT
<br />ACTIONS MAY RESULT IN CIVIL PENALTIES AND /OR REVOCATION OF YOUR PERMIT.
<br />Office of Office of
<br />Mined Land Reclamation Denver • Grand Junction • Durango Active and Inactive Mines
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