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VYli.00105L <br />Application Checklist <br />1 I Application Form: Complete the foiui located on page 5. <br />yn ❑ Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />.50/4 and Safety. 1126 .. , N q <br />`p 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 />fid 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 />04' 6 <br />-4 <br />RECEIVED <br />FEB 09 2016 <br />Division of Reclamation, <br />Mining & Safety <br />