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COLORADO <br /> Division of Reclamation, <br /> Mining and Safety <br /> D ra,tri-nt of Nahlr.11e,,,Ivr-e; <br /> 1313 Sherman St. Room 215 <br /> Denver, CO 80203 <br /> November 1,2017 <br /> Trinidad Martinez <br /> Costilla County <br /> P.O. Box 130 <br /> San Luis,CO 81152 <br /> Costilla,Permit M-1980-233,Annual Fee Invoice and Report Request <br /> PLEASE READ CAREFULLY—ACTION REQUIRED <br /> Please attach your COMPLETED written Annual Report 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 /> 1. 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-1980-233 <br /> Operation Name: Costilla <br /> Anniversary Date: December 11,2017 <br /> Total Fee Due: $323.00(Due on or before your Anniversary Date) <br /> A y, <br /> 1313 Sherman St. Room 215 Denver, CO 80203 P(303)866-3567 F <br /> John W Hickentooper,Governor I Robert W Randall, Executive Director i Virginia Brannon, Director <br />