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pi 1017- qY3 <br />R( <br />Application Checklist <br />1�d Application Form: Complete the form located on page 5. <br />Ea' Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />12 Performance 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 http://mining.state.co.us/Mineral%20Forms htm). <br />�I F Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />C a:tt-, rights, obtain the documentation described above, and submit to the Division. <br />t ni-')�vjJW*4—�7 ❑ Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. <br />I OCT 0 6 2015 <br />DIVISION OF RECLAMATION <br />MINING AND SAFETY <br />-4- <br />