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NOTARY FOR PROSPECTIVE SUCCESSOR <br />STATE OF ) <br />} ss.: <br />COUNTY OF } <br />by <br />The foregoing instrument was acknowledged before me this <br />as <br />day of <br />of _._ <br />Notary Public <br />My Commission Expires <br />STATE APPROVAL <br />for completion by Division] <br />(a) The Board hereby approves the transfer of permit number <br />to <br />from <br />(b) The Board hereby recognizes as Successor Operator under <br />such Permit. <br />(c) The Board hereby accepts the Performance and Financial Warranties submitted by Successor and hereby <br />releases _....... . , as former Permittee from all obligations under <br />its Performance and Financial Warranties. The Board further releases all affected financial warrantors from <br />obligations under Financial Warranties associated with the former Permittee. <br />STATE OF COLORADO <br />DEPARTMENT OF NATURAL RESOURCES <br />MINED LAND RECLAMATION BOARD <br />DIVISION OF RECLAMATION, M 41NG AND SAFETY <br />By: Date Executed: <br />Division Director <br />_]0_ <br />