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Co Z. L A 3 o <br />Street <br />Street <br />P.O. Box <br />Pow)-(" /d/ r (h, / U <br />City, State, Zip City, State, Zi <br />(g-�6 ) y-�i -- 96(8zg) 30-1)i� <br />Telephone Telephone <br />(9-70 ) �W -066qZ ( ) <br />Fax Fax <br />4. APPLICATION FEE: $86. (NOIs require an $86 fee which must accompany this notice <br />or it cannot be processed by the Division). <br />5. <br />LOCATION INFORMATION: <br />County: <br />Principal Meridian (check one): <br />® 6t" (Colorado) 10t" <br />® <br />(New Mexico) <br />Section (write number) TOWNSHIP <br />RANGE [1] E FZ—] <br />W <br />QUARTER SECTION (check one): <br />NEC NW ❑ SE R SW ❑ <br />QUARTER/QUARTER SECTION (check one): <br />NE F—] NW ❑ SE C SW ❑ <br />Ute <br />�g N Sol <br />GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the <br />approximate elevation): <br />S -U <br />Form I — DRMS Use and Confidential File <br />Page 2 of 14 <br />