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State otcoioriZATE OF COLORADO <br /> Depanment <br /> DIVISION OF of Natural Resources Department of MINERALS AND GEOLOGY Division of Reclamation, Mining and Safety <br /> 1313 Sherman St., Room 215 RE ON: RECEIVED <br /> Denver,Colorado 80203 D I V I S I O N O F <br /> Phone:(303)866-3567 �f/�G �C T MINERALS <br /> FAX:(303)832-8106 1/,�-1 !ry lr� ta-t�b, OCT Q 7 2002 & <br /> _rnul GEOLOGY <br /> Y. Division of Minerals and G=�lagy R E C L A M A T I O N <br /> MINING-SAFETY <br /> ASSIGNMENT OF CERTIFICATE OF DEPOSIT <br /> Bill Owens <br /> Governor <br /> TO WHOM IT MAY CONCERN: / G eg E.Walcher <br /> Director <br /> ��� ,p� <br /> REFERENCE: Certificate of D Michael B.Long <br /> e osit Number <br /> Division Director <br /> By submission of this letter,to be attached to the above referenced Certificate of Deposit,I hereby relinquish all title and <br /> claim to said certificate to the State of Colorado./Mined Land Reclamation Board,except for accrued interest against the <br /> original monies,until such time as the Division of Minerals and Geology/Mined Land Reclamation Board releases the <br /> certificate. This assignment of Certificate of Deposit supersedes any signature cards that may already be on file at the bank. <br /> BY. ,. <br /> Signature <br /> Operator: F-4 e <br /> l5eepositor ot Original Monies <br /> ACKNOWLEDGMENT OF BANK: <br /> UA-__ �� _�\ )�7)pl �c j— a <br /> _SIGNATURE RY p Y(Of Operator Si ature) <br /> BY: of Expires "a �- <br /> 2: KAT1E <br /> TITLE: C �� ; NAUYOKAS <br /> DATE: <br /> OF c0�-°¢ <br /> Return Original Form to: Division of Minerals and Geology <br /> 1313 Sherman St.,Rm 215 <br /> Denver, CO 80203 <br /> Note to Operator: <br /> This assignment form will need to be executed in the presence of a notary. The original is held by the Division with a copy <br /> provided to the bank to allow only the Division of Minerals and Geology access to these funds. <br /> M:\min\share\bondfoms\cdassignfomr.bnd.doe <br /> REVISED 02/14/02 <br />