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Ill I ie'?0! <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 />El Performance Warranty: Complete the form located on page 11. <br />a Financial Warranty: Submit the appropriate Financial Warranties or conditional <br />replacement Financial Warranties using the forms posted on the Division's website <br />(available online at httv://mining.state.co.us/Mineral°/o20Forins.htin . <br />0 Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />rights, obtain the documentation described above, and submit to the Division. <br />Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />to do so. <br />-4- <br />RECEIVED <br />DEC 1 9: 2016 <br />Division of Reclamation, <br />Mining & Safely <br />