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71.1 <br /> JAN 0 4 2017 <br /> C + LORADO <br /> ® ; Division of Reclamation, <br /> .. Mining and Safety <br /> Department of Natural Resources pq ` <br /> 1313 Sherman St.Room 215 '� <br /> Denver,CO 80203 <br /> January 2,2017 po 0 <br /> Kane Schneider " 0 " y°?149 3 ad 61 7 <br /> Colorado Department of Transportation <br /> 606 S.9th St. <br /> Grand Junction,CO 81501 <br /> Independence Pass,Permit M-1984-103,Annual Fee Invoice and Report Request <br /> PLEASE READ CAREFULLY—ACTION REQUIRED <br /> Please attach your COMPLETED written Annual Report and Annual Report Man to this form <br /> Under the terms of your Reclamation Permit and Colorado Statutes,you must submit an Annual Fee and <br /> Annual Report(including a map). You must pay the Annual Fee and submit an Annual Report each year <br /> until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report <br /> are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was <br /> inactive. <br /> The Annual Report and Fee requirement will be considered submitted when we have received the <br /> following components: <br /> I. APPROPRIATE ANNUAL FEE <br /> 2. COMPLETED ANNUAL REPORT <br /> 3. ASSOCIATED MAP as required by rule <br /> If you have requested reclamation responsibility release from the Division of Reclamation, Mining and <br /> Safety(the"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$323.00 fee is due for the following: <br /> Permit: M-1984-103 <br /> Operation Name: Independence Pass <br /> Anniversary Date: February 1,2017 <br /> Total Fee Due: $323.00(Due on or before your Anniversary Date) <br /> I hereby certify that I have received the goods or services listed <br /> hereon,thet(have carefully inspected weighed, counted or <br /> measured the commodities and found them to good condition <br /> and corrplying with the specifications given or that the goods <br /> and service-- are in contract compliance,or that the services <br /> were satisfactory except as not t <br /> IiUate recieved Signature of Person acts s/se foes <br /> /Cxr <br /> Patrol/t Print Name <br /> N <br /> Cost Center Obl. — /Sub. Function <br /> 1313 Sherman St.Room 215 Denver,CO 80203 P(303)866-3567 F H , : o' <br /> John W.Hickenlooper,Governor I Robert W. Randall,Executive Director i Virginia Brannon,Director <br />