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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman SL,Room 215 <br /> Denver,Colorado 80203 pC O L O Ro N D O <br /> Phone(303)566.3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> SAFETY <br /> ASSIGNMENT OF CERTIFICATE OF D POSI <br /> TO WHOM IT MAY CONCERN: <br /> REFERENCE: Certificate of Deposit Number <br /> By submission of this letter,to be attached to the above referenced Certificate of Deposit,I hereby relinquish all title and <br /> claim to said certificate to the State of Colorado/Mined Land Reclamation Board,except for accrued interest against the <br /> original monies,until such time as the Division of Reclamation,Mining and Safety/Mined Land Reclamation Board releases <br /> the certificate. This assignment of Certificate of Deposit supersedes any signature cards that may already be on file at the <br /> bank. <br /> BY: �- <br /> 7 <br /> Operator: ! Gt '-'r) <br /> Depositor of Original Monies <br /> ACKNOWLEDGMENT OF BANK <br /> N T Y{Of O M r <br /> `� Sig}atu <br /> Commission Expires ��.•JJ <br /> SIGNATURE: C � � Comm <br /> BY: <br /> JENNIFER RIDNOUR <br /> TITLE:_ NOTARY PUBLIC <br /> / STATE OF COLORADO <br /> DATE: �5/ A-1 NOTARY ID#20044038288 <br /> -`7 My Commission.Expiro.*:October,25,2020 <br /> Note to Operator: <br /> This assignment will need to be executed in the presence of a notary. The original is held by the Division with a <br /> copy provided to the bank,to allow only Division of Reclamation,Mining and Safety access to these funds <br /> Office of Mined Land Reclamation Office of <br /> Denver . Grand junction • Durango Active and Inactive Mines <br />