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COLORADO <br />Division of Reclamation, <br />a 17 A& - <br />Mining and Safety <br />Department of Natural Resources <br />1313 Sherman St. Room 215 <br />Denver, CO 80203 <br />September 1, 2017 <br />Forrest Neuerburg <br />City of Monte Vista <br />95 W, 1st <br />Monte Vista, CO 81144 <br />Lagoon Pit, Permit M-1992-060, Annual Fee Invoice and Report Request <br />PLEASE READ CAREFULLY — ACTION REQUIRED <br />Please attach vour COMPLETED written Annual Re ort and Annual Report Map to this form <br />Under the terms of your Reclamation Permit and Colorado Statutes, you must submit an Annual Fee and <br />Annual 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 will be considered submitted when we have received the <br />following components: <br />I. APPROPRIATE ANNUAL FEE <br />2. COMPLETED ANNUAL REPORT <br />3. ASSOCIATED MAP as required by rule <br />If you have requested reclamation responsibility release from the Division of Reclamation, Mining and <br />Safety (the "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 />Permit: M-1992-060 <br />Operation Name: Lagoon Pit <br />Anniversary Date: October 20, 2017 <br />Total Fee Due- $323,00 (Due on or before your Anniversary Date) <br />F•Cp <br />I �e <br />1313 Sherman St. Room 215 Denver, CO 80203 P (303) 866.3567 F "**�* <br />John W. Hickenloaper, Governor I Robert W. Randall, Executive Director I Virginia Brannan, Director <br />* 1876 <br />