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tA <br /> Application Checklist <br /> 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 /> Pf Performance Warranty: Complete the form located on page 11. <br /> 4—IN <br /> " 10 Financial Warranty: Submit the appropriate Financial Warranties or conditional <br /> ,( �G j�',ss� replacement Financial Warranties using the forms posted on the Division's website <br /> ` (available online at http://mining.state.co.us/Nlineral%20Forms.htm). <br /> a(i tn'1i�j`inic (� Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br /> U rights, obtain the documentation described above and submit to t e Division. <br /> OOK'5 t Pr c�t,'1l Ge rS <br /> ❑ Structure Agreements: Obtain nvl ew Structure Agreemen& if Permittee had been required <br /> to do so. I <br /> RECEIVED <br /> JUN 16 2016 <br /> Division of Reclamation, <br /> Mining& Safety <br /> -4 - <br />