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Application Checklist <br />CQ 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 />MPerformance 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 hqp://mining.state.co.us/Mineral%20Fonns.htm). <br />Gd 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 />®'Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. <br />Na <br />-4- <br />RECEIVED <br />'JUN 19 2015 <br />mifni�e 4 <br />