2019-03-23_GENERAL DOCUMENTS - M1980249 ‎(3)‎

• Permit No: M1980249
• IBM Index Class Name: General Documents
• Doc Date: 3/23/2019
• Doc Name: Complaint
• From: Kayle Higinbotham
• To: DRMS
• Email Name: TC1
• Email Name: MAC
• Media Type: D
• Archive: No

COLORADO
DRMS Complaint Intake Tool Division of Reclamation,
Mining and Safety
Department of Natural Resources
By Submitting this form you are requesting an investigation of
compliance with DRMS rules.
COMPLAINANT INFORMATION
Date of Complaint
03/23/2019
Indicates a Required Field
Do you wish to remain anonymous?
r Yes r No
Your First Name
Kayle
Your Last Name
Higinbotham
Your Address
5975 Wellington Rd
Your City*
Chipita Park
Your State
CO
Your Zip Code
Maximum of 10 digits. (Example)80202
80809
Email Address
Enter a valid email address in this field to receive a confirmation e-mail and copy of your Complaint form.
[e-mail]
Your Phone Number*
Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890
719-492-5178
Alternate Phone Number
Used only to follow up. Please enter phone number in this format: (Example) 123-456-7890
Connection to Incident
Select all that apply
❑ Land Owner r Mineral Owner
P Nearby Resident I- Observed Incident
r Other
DESCRIPTION OF COMPLAINT
(Please be as specific as possible)