2016-12-16_REPORT - M1977227

• Permit No: M1977227
• IBM Index Class Name: Report
• Doc Date: 12/16/2016
• Doc Name: Annual Fee Notice
• From: DRMS
• Annual Report Year: 2017
• Media Type: D
• Archive: No

1313 Sherman St. Room 215 Denver, CO 80203 P [phone] F
John W. Hickenlooper, Governor | Robert W. Randall, Executive Director | Virginia Brannon, Director
1313 Sherman St. Room 215
Denver, CO 80203

Mesita Hill Pit, Permit M-1977-227, Annual Fee Invoice and Report Request

PLEASE READ CAREFULLY – ACTION REQUIRED
Please attach your COMPLETED written Annual Report and Annual Report Map to this form

Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and
Annual Report (including a map). You must pay the Annual Fee and submit an Annual Report each year
until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report
are for LAST YEAR’S mining and reclamation season, and MUST be paid even if your operation was
inactive.

The Annual Report and Fee requirement will be considered submitted when we have received the
following components:

1. APPROPRIATE ANNUAL FEE
2. COMPLETED ANNUAL REPORT
3. ASSOCIATED MAP as required by rule

If you have requested reclamation responsibility release from the Division of Reclamation, Mining and
Safety (“Division”) but your permit is not released by the anniversary date listed below, the Annual Fee
MUST be paid. If the permit is released before the anniversary date, then by Statute, it is not necessary to
pay an Annual Fee or submit an Annual Report for that year.

Division records indicate the $791.00 fee is due for the following:
Permit: M-1977-227
Operation Name: Mesita Hill Pit
Anniversary Date: February 9, 2017
Total Fee Due: $791.00 (Due on or before your Anniversary Date)

January 2, 2017
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