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Operator (If Other than Permittee): (Same) <br /> Permittee Representative: Lynn Mayer Shults <br /> Certified Mail # <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 Address Phone Number <br /> L.G. EVERIST, INC. 7321 E 88TH AVENUE, SUITE 200 303-286-2247 <br /> (Property Owner of parcels in HENDERSON, CO 80640 <br /> area to be released - Parcels <br /> 130930301002, 130930301003, <br /> and130931103001) <br /> KP KAUFFMAN COMPANY, 1675 Broadway#2800 303-825-4822 <br /> INC. Denver, CO 80202 <br /> (Oil & Gas rights - Parcel <br /> 130930301003) <br /> CRESTONE PEAK 1801 California Street, Suite 2500 720-410-8500 <br /> RESOURCES, LP Denver, CO 80202 <br /> (Oil & Gas rights - Parcel <br /> 130930301003) <br /> Bronn & Renee Strange 1620 W 83RD AVE <br /> (Parcel 130931201003) DENVER, CO 80221 303-423-3223 <br /> Gary Strange and Larry Torres 12845 JASMINE WAY <br /> (Parcel 130931201004) THORNTON, CO 80602 303-920-5015 <br /> Mary and Danny Crawford 12341 COUNTY ROAD 14 1/2 <br /> (Parcel 130931201005) FORT LUPTON, CO 80621 970-587-5505 <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 /> Signature of Permittee, Ope'ra<r or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.10) This release request must be submitted to the <br /> Division via certified mail and separate om any other correspondence to the Division. <br /> MmeralsReleaseReque(form 20Sep2017 <br /> Page 2 of 2 <br />