2016-12-06_REPORT - M1982075

• Permit No: M1982075
• IBM Index Class Name: REPORT
• Doc Date: 12/6/2016
• Doc Name: Annual Fee/Report/Map
• From: Alvin & Patricia Mosch
• To: DRMS
• Email Name: MAC
• Media Type: D
• Archive: No

The above contact information is no longer valid and must be changed for future
correspondence. Patricia Mosch is deceased and her portion of the property now is owed by
David Mosch. Future correspondence should be as follows:
Permittee Contact: David Mosch
Permittee Company: Alvin Mosch-David Mosch
Address:
C/O David Mosch
P.O. Box 1484
Idaho Springs, CO 80452
Phone Number: [phone]
Fax Number: N/A
Email Address: [e-mail]
I,the undersigned, hereby state that the information provided in this report is true and
accurate, and that site operations are being conducted in accordance with the Division
approved mining and reclamation plans.
Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
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