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BANK OF COLORADO 1103 <br /> SELECT MATERIALS az-zaai1o13 <br /> PO BOX 740 <br /> FORT LUPTON,CO 80621 9/13/2016 <br /> 303-857-4688 -- . Y <br /> U <br /> N <br /> m <br /> C <br /> O <br /> PAYTOTHE DIVISION OF RECLAMATION, MINING &SAFETY s**791.00 <br /> ORDER OF <br /> _Seven Hundred Ninety-One and 00/100** x** ******** ******* ********************************** ********* *** ** **** , <br /> DOLLARS <br /> DIVISION OF RECLAMATION, MINING &SAFETY <br /> 1313 SHERMAN ST wNi�iao <br /> ROOM 215 INAI ORIGINA <br /> N3D" 3WAN31 <br /> DENVER, CO 80203 <br /> MEMO "Gv.,.,no "i M' Z <br /> PERMIT NO M-1980-205 AUTHORIZED SIGNATURE <br /> d <br /> 1 <br /> SELECT MATERIALS 1103 <br /> DIVISION OF RECLAMATION, MINING & SAFETY 9/13/2016 <br /> Date Type Reference Original Amt. Balance Due Discount Payment <br /> 9/13/2016 Bill M-1980-205 791.00 791.00 791.00 <br /> Check Amount 791.00 <br /> _ �y j <br /> dc-) <br /> S 4,4 r7 e-1 <br /> Coo c.U-tie Yid <br /> Bank of Colorado- Mi PERMIT NO M-1980-205 791.00 <br /> If you have requested reclamation responsibility release from the Division of Reclamation, Mining and <br /> Sa%ty ("Division") but your permit is not released by the anniversary date listed below, the Annual Fee <br /> MUST be paid. If the permit is released before the anniversary date,then by Statute, it is not necessary to <br /> pay an Annual Fee or submit an Annual Report for that year. <br /> Division records indicate the$791.00 fee is due for the following: <br /> Permit: M-1980-205 <br /> Operation Name: Select Materials <br /> Anniversary Date: October 2, 2016 <br /> Total Fee Due: $791.00(Due on or before your Anniversary Date) <br /> OF'cOL <br /> 0� <br /> �e4 , 9a, <br /> 1313 Sherman St. Room 215 Denver, CO 80203 P (303)866-3567 F 01 <br /> r( am . <br /> John W. Hickenlooper, Governor I Robert W. Randall, Executive Director I Virginia Brannon, Director <br /> 876* <br /> `�J <br />