2017-04-17_M2000073_Annual Fee Notice ARCHIVE

• Permit No: M2000073A
• IBM Index Class Name: Report
• Doc Date: 4/17/2017
• Doc Name: Annual Fee Notice
• From: DRMS
• To: XTO Energy Inc.
• Annual Report Year: 2017
• Media Type: D
• Archive: Yes

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:

Kelly Kardos
Permittee Company:

XTO Energy Inc.
Address:

P.O. BOX 6501
ENGLEWOOD, CO 80155

Phone Number:

[phone]
Fax Number: [phone]
Email Address: [e-mail]
Permitting Contact:

Kelly Small
Company:

XTO Energy Inc.
Address:

382 Road 3100
Aztec, NM 87410

Phone Number:

Fax Number:
Email Address:
Inspection Contact:

Kelly Small
Company:

XTO Energy Inc.
Address:

382 Road 3100
Aztec, NM 87410

Phone Number:

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.

Signature of Permittee, Corporate Officer, Owner, or Documented Designee Date

M-AF-04