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STATE OF COLORADO <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> Department of Natural Resources <br /> 1313 Sherman St.,Room 215 COLORADO <br /> Denver,Colorado 80203 o r v t s r o N o e <br /> Phone:(303)866-3567 RECLAMATION <br /> FAX:(303)832-8106 MINING <br /> SAFETY <br /> ASSIGNMENT OF CERTIFICATE OF DEPOSIT <br /> TO WHOM IT MAY CONCERN: <br /> REFERENCE: Certificate of Deposit Number <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 /> BY: <br /> Z UV <br /> Operator: Romeo Sand & Gravel, LLC <br /> Depositor of Original Monies <br /> ACKNOWLEDGMENT OF BANK �(M a D lhaj-' <br /> NOT Y(Of Operator Si re)II&. -k ++�� <br /> Commission Expires <br /> SIGNATURE <br /> BY: <br /> LYNNAE SHAWCROFT <br /> TITLE: Q uc�> A-� � NOTARY PUBLIC <br /> STATE OF COLORADO <br /> / NOTARY ID 20074035945 <br /> DATE: U� leg [My COMMISSION EXPIRES SEPT.27,2019 <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 Office of <br /> Mined Land Reclamation Denver • Grand junction • Durango Active and Inactive Mines <br />