Laserfiche WebLink
New Horizon North Mine <br />NT <br />f <br />U/ <br />United States Department of the Interior <br />FISH AND WILDLIFE SERVICE <br />Migratory Bird Permit Office, Region 6 <br />IN REPLY REFER r0 MAILING ADDRESS: STREET LOCATION: <br />USFWS/PERMITS Post Office Boz 25486 134 Union Blvd. <br />Mail Stop 60154 Denver Federal Center (60154) Lakewood, Colorado 80228 <br />EAIT Denver, Colorado 80225 <br />December 1, 2016 <br />Eagle Take Associated with but not the Purpose of an Activity <br />2016 Annual Report Checklist <br />Please complete and return with required documents <br />f(`� <br />Permit Number#: ` Ig-) S5 1� 0 <br />I --t/Complete and sign the 2016 Annual Report form. Annual report forms should be signed by the Principal Officer. <br />2 _ Name ofcurrent Principal Officer: 0 Title: _�e jC}(0 1G[1ta _ <br />(even if it has not changed from the previous <br />3._ _ List of current Subperminees: <br />(even if they have not changed from the previous year, if you do not have subperminecs please indicate "none") <br />4. Current Mailing Address rind Physical Address: l'_1[1a�k , `.� . `)N �j�j�gCj S t CCj*W3a3—� <br />(even if it has not changed from the previous year) <br />5._ V'Current Phone Number and E-mail Address: 3U� <br />(even if it has not changed from the previous veer) V J <br />Please note: <br />If there was no activity during 2016, an Annual Report indicating "no activity" is still required to be submitted. <br />If you do not use the enclosed Annual Report form, please ensure that your report follows the same format as the Annual <br />Report form provided by the U.S. Fish & Wildlife Service. <br />If you have any questions please contact our office at 303-236-8171. <br />Migratory Bird Permit Office <br />Denver, Colorado <br />2016 Annual Reclamation Report Page 12 <br />