2017-03-23_REPORT - M1991082

• Permit No: M1991082
• IBM Index Class Name: Report
• Doc Date: 3/23/2017
• Doc Name: Annual Fee/Report/Map
• From: Estate of Frank Laughrey
• To: DRMS
• Annual Report Year: 2017
• Email Name: ERR
• Media Type: D
• Archive: No

Page 5 of 5
Division records indicate the following permittee/landowner contact information(blank fields indicate that we do not have
information on record). If this information is blank or not current,please type or print current contact information:
Permittee Contact: Jay Baker
Permittee Company: Estate of Frank Laughrey
Address: P.O.Box 7258
Woodland Park, CO 80863
Phone Number: [phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact: Larry Laughrey
Company: Estate of Frank Laughrey
Address: P.O.Box 153
Forbestown, CA 9594 1-0 1 5 3
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Larry Laughrey
Company: Estate of Frank Laughrey
Address: P.O. Box 153
Forbestown, CA 95941-0153
Phone Number: [phone]
Fax Number:
Email Address:
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.
l
Signature of Permittee,Corporate Officer,Owner,or Documented Designee Date
M-AF-01