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1,4 j -n-L ? <br />Application Checklist <br />kt off Y RI Application Form: Complete the form located on page 5. <br />Sj,6y1-& 0 Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. 5 <br />ZAtA d Performance Warranty: Complete the form located on page 11. <br />a 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 />Aa464/M-t- 444/VW <br />0 Demonstration of 1gal Right to Enter: Identify the owners of all surface and mineral <br />rights, obtain the documentation described above, and submit to the Division. <br />1 ❑ Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. <br />Y 1Qc d� 'le/A Mu, moi, 0iue. 4112O/ <br />4 <br />RECEIVED <br />JAN 2C2C <br />Midi"'cif`F'eCTam'atiori <br />Mining &-Safety, <br />