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COLORADO <br /> AT n / <br /> Division of 11w1aination, - P CVMbiing and <br /> Departinent of Natural mResources (K7��✓f <br /> 1313 Shermm St.Room 215 <br /> t)enver,CO 80203 C _ <br /> May 1,2017 oilo <br /> r <br /> Suzanne M.Theisen <br /> Theisen Mineral <br /> 1251 Bailey Dr. <br /> Brighton,CO 80603 <br /> Suenne Marie,Per wilt M-2N9493,Annual Fee Invoice and Report It"nest <br /> PLEASE READ CAREFULLY—ACTION REQUIRED <br /> Please attach your COMPLETED wiri(ten Annual Report and Annual Resort Mrlp Ig thk form <br /> Under the terms of your Reclamation Permit and Colorado Statutes,you merit submit an Annual Fee and <br /> Armual Report(including a map). You must pay the Annual Fee and submit an Annual Report each year <br /> until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report <br /> are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was <br /> inactive. <br /> The Annual Report and Fee requirement w8I be considered submitted when we have received the <br /> following components: <br /> 1. APPROPRIATE ANNUAL FEE <br /> 2, COMPLETED ANNUAL 1tEPORT <br /> 3. ANOCUTSD MAP as mulred by rule ✓ <br /> If you have requested reclamation responsibility release from the Division of Reclamation, Mining and <br /> Safety("Division")but your Permit is not released by the anniversary date listed below,the Annual Fee <br /> MUST be paid. If the permit is released before the anniversary date,then by Statute,it is not necessary to <br /> pay an Annual Fee or submit an Annual Report for that year, <br /> Division records indicate the$323.00 fee is due for the following; <br /> Pemeit: M-2009.093 <br /> Operation Name: Suzanne Marie <br /> Anniversary Date: Jenne 22,2017 <br /> Total Fee Due: $323.00(Due on or before your Anniversary Date) <br /> 1313 Sherman 5t.Room 215 Denver,CO 60203 P(303)866 3567 F etie <br /> Jahn W.Hickentooper,Governor 4 Robert W.Randalt,Executive Director 4 Virginia Brannon.Director �' g ;'•«' <br />