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CIA/11l;, r✓I a SMO )3 <br /> CIA/111/1 <br /> Application Checklist <br /> Pi Application Form: Complete the form located on page 5. <br /> GDV w V v ❑ Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br /> and Safety. re,c,,et 'Si t5 rtx 4- 61'JU 1 )61C <br /> ,21/. Performance Warranty: Complete the form located on page 11. <br /> �.� ❑ Financial Warranty: Submit the appropriate Financial Warranties or conditional <br /> replacement Financial Warranties using the forms posted on the Division's website <br /> (available online at http:;;mining.state.co.us,'Mineral%2OForms.htm). <br /> yy�L ❑ Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br /> rights, obtain the documentation described above, and submit to the Division. <br /> ❑ Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br /> to do so. <br /> RECEIVED <br /> 101 DEC 11 2011 <br /> .�7 <br /> � Nvision of Reclamation, <br /> Mining&Safety, <br /> -4- <br />