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Operator (If Other than Permittee): (Same) <br />Permittee Representative: Lynn Mayer ShultS <br />Certified Mail ff <br />In accordance with Rule 4.17.1(2) the Operator shall include the names, addresses and phone numbers of all <br />owners of record to the affected land. Please attach additional sheets for this information if required. <br />Name <br />L.G. EVERIST, INC. <br />(Property Owner of parcel <br />to be released - <br />Parcel 131106200012) <br />PDC Energy, Inc. <br />(Oil & Gas rights - Parcel <br />131106200012) <br />Address <br />7321 E 88TH AVENUE, SUITE 200 <br />HENDERSON, CO 80640 <br />1775 Sherman Street, Suite 3000 <br />Denver, CO 80203 <br />Phone Number <br />303-286-2247 <br />303-860-5800 <br />In accordance with Rule 4.17.1(4), if requesting a partial acreage release the Operator or their agent MUST sign that <br />they have complied with the following statement: "All applicable portions of the Reclamation Plan requirements <br />have been satisfied in accordance with these Rules and all applicable requirements under the Act." <br />/71' <br />Signature of Permittee, Operator or their authorized agent Date <br />Important: In accordance with Rules 4.14.2 a and 4.17.1 0) This release re nest must be submitted to the <br />Division via certified mail and separate from any other correspondence to the Division. <br />MmeralsReleaseRequesiPorm Mep2017 <br />Page 2 of 2 <br />