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, Operator(If Other than Permittee): <br /> Permittee Representative: Albert R. Frei, Jr. <br /> Certified Mail# 1 S P )--)f)0 � 00r)"7 <br /> In accordance with Rule 4.17.1(2)1 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 /> AR & MJ Frei Limited Partnership P.O.Box 700, Henderson, CO 80640 303-289-1837 <br /> Clear Creek County <br /> C/O Robert Loeffler, ESQ. P.O. Box 2000, Georgetown, CO 80444 303-679-2498 <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, Operator or their authorized agent Date <br /> Important: In accordance with Rules 4.14.2(a) and 4.17.1(3) This release request must be submitted to the <br /> Division via certified mail and separate from any other correspondence to the Division. <br /> MineralsReleaseReques[Form 20Sep2017 <br /> Page 2 of 2 <br />