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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY S <br /> ap U�� afetiY <br /> Department of Natural Resources ate pf Coto, <br /> p\p(O Nabl0 R Mph. (j and 8 Mr <br /> 1313 Sherman St,Room 215 state t ecla for, tRLECLkMATION <br /> O R A D O <br /> Denver,Colorado 80203 O p Of SION OF <br /> Phone:(303)866 3567 pw%s'%o ( <br /> INING <br /> FAX:(303)832-8106 SEo OR. yJ — IN <br /> R�LEP Ir SAFETY <br /> woo r 'G' <br /> �(r0 <br /> BYa NMENT OF CERTIFICATE OF DEPOSIT <br /> TO WHOM IT MAY CONCERN: <br /> REFERENCE: Certificate of Deposit Number 017949305 <br /> By submission of this letter,to be attached to the above referenced Certificate of Deposit,I hereby relinquish all title and <br /> claim to said certificate to the State of Colorado/Mined Land Reclamation Board,except for accrued interest against the <br /> original monies,until such time as the Division of Reclamation,Mining and Safety/Mined Land Reclamation Board releases <br /> the certificate. This assignment of Certificate of Deposit supersedes any signature cards that may already be on file at the <br /> bank. <br /> 1 � <br /> BY.. <br /> operator: JOSEPH WESTHOFF <br /> Depositor of Original Monies <br /> i <br /> ACKNOWLEDGMENT OF BANK <br /> NO ARY((Of Operator S• <br /> Commission Expires JJ <br /> SIGNATURE: <br /> BY: c <br /> �n <br /> TITLE. <br /> DATE: <br /> Note to Operator: <br /> This assignment will need to be executed in the presence of a notary. The original is held by the Division with a <br /> copy provided to the bank,to allow only Division of Reclamation,Mining and Safety access to these funds <br /> Office of <br /> Office of Active and Inactive Mines <br /> Mined Land Reclamation Denver • Grand)unction • Durango <br />