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Application Checklist <br />M a-o /a - 0 7 <br />JAN 21.2015 <br />El Application Form: Complete the form located on page 5. <br />G1rwn o%ReaRrr-f- ®►vleloo of R @ @1 @m @1( ®H1 <br />Mining & B @f�+ <br />�� ' '�i Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />113oIA01tr XL Performance Warranty: Complete the form located on page 11. <br />al wA015 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: / /minina.state.co us/Mineral %2OForms htm). <br />R {L� t��1�5 $ 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 />/04� ® Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />RUC, 1130115 to do so. <br />,�VLJ 9TiP i3l (0 117,)15 <br />