2018-01-26_GENERAL DOCUMENTS - M2007067

• Permit No: M2007067
• IBM Index Class Name: General Documents
• Doc Date: 1/26/2018
• Doc Name Note: Request for S.O.
• Doc Name: Correspondence
• From: DRMS
• To: Marathon Oil Company c/o Caerus Oil and Gas LLC
• Email Name: ACY
• Email Name: GRM
• Email Name: BJC
• Media Type: D
• Archive: No

SIGNED, SEALED AND DATED this day of
STATE OF
COUNTY OF
by
Operator
IM
Title:
{SEAL}
NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT
ss..
The foregoing instrument was acknowledged before me this day of
as
of
Notary Public
My Commission Expires
STATE OF COLORADO
DEPARTMENT OF NATURAL RESOURCES
MINED LAND RECLAMATION BOARD
DIVISION OF RECLAMATION, MINING AND SAFETY
By: Date Executed:
Division Director
Rev. 45! 12
- 13 -