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�04 <br />Application Checklist <br />� tires M Application Form: Complete the form located on page 5. <br />e� <br />M I qq Pass <br />Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />® Performance Warranty: Complete the form located on page 11. <br />C<r 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:!/m i ni n g. state.co.us/M inera 1%20 Forms. h tm). <br />7 Lelflgk7�L ❑ Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />a{ whn-i-+ rights, obtain the documentation described above, and submit to the Division. <br />mss+ o ff'e� <br />1j-ytG ❑ Structure Agreements: Obtain ne%v Structure Agreements if Permittee had been required <br />to do so. <br />RECEIVED <br />APP 06 2017 <br />Reclamation, <br />�r1�r Ing & Safety <br />-4- <br />