2017-03-17_REPORT - M2010047

• Permit No: M2010047
• IBM Index Class Name: Report
• Doc Date: 3/17/2017
• Doc Name: Annual Fee/Report Notice
• From: DRMS
• To: Miller Family Investments
• Annual Report Year: 2017
• Permit Index Doc Type: Annual Fee/Report
• 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:

Brady Miller
Permittee Company:

Miller Family Investments, LLC
Address:

428 N. 2nd Street
La Salle, CO 80645

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Permitting Contact:

Ryan Ellis
Company:

Greg Lewicki and Associates
Address:

11541 Warrington Court
Parker, CO 80138

Phone Number:

[phone]
Fax Number: [phone]
Email Address:
Inspection Contact:

Brady Miller
Company:

Miller Family Investments, LLC
Address:

428 N. 2nd St.
La Salle, CO 80645-3308

Phone Number:

[phone]
Fax Number: [phone]
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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date
M-AF-01