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i COLORADO Division of Reclamation, Mining and Safety Department of Natural Resources 1313 Sherman St. Room 215 Denver, CO 80203 September 1, 2017 CF.PR.Contact_first_name CF.PR.Contact_middle_init.CF.PR.Contact_last_name CF.PR.Company_name CF.PR.Address_I CF.PR.Address_2 CF.PR.City,CF.PR.State CFYR.Zip_code Golden Mine,Permit M-1976-007-UG,Annual Fee Invoice and Report Request PLEASE READ CAREFULLY—ACTION REQUIRED Please attach your COMPLETED written Annual Report and Annual Report Map to this form Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and Annual Report(including a map). You must pay the Annual Fee and submit an Annual Report each year until reclamation responsibility release is granted. The Annual Fee is not a renewal fee. The Fee and Report are for LAST YEAR'S mining and reclamation season, and MUST be paid even if your operation was inactive. The Annual Report and Fee requirement will be considered submitted when we have received the following components: 1. APPROPRIATE ANNUAL FEE 2. COMPLETED ANNUAL REPORT 3. ASSOCIATED MAP as required by rule If you have requested reclamation responsibility release from the Division of Reclamation, Mining and Safety ("Division") but your permit is not released by the anniversary date listed below, the Annual Fee MUST be paid. If the permit is released before the anniversary date,then by Statute, it is not necessary to pay an Annual Fee or submit an Annual Report for that year. Division records indicate the $323.00 fee is due for the following: Permit: M-1976-007-UG Operation Name: Golden Mine Anniversary Date: October 4,2017 Total Fee Due: $323.00(Due on or before your Anniversary Date) F-COLO�, 1313 Sherman St. Room 215 Denver,CO 80203 P(303)866-3567 F *� ��. o, John W. Hickenlooper. Governor I Robert W. Randall, Executive Director I Virginia Brannon, Director *1876