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TAB 3 <br />TABLE OF CONTENTS <br />Page <br />Rule 2.03.4 Identification of Interests 3-1 <br />2.03.4(1) Statement of Incorporation <br />2.03.4(2) Names and Addresses <br />2.03.4(2)(a) Owner/Applicant/Operator <br />2.03.4(2)(b) Resident Agent <br />2.03.4(2)(c) Person Responsible for AML Fee 3-2 <br />2.03.4(3) Ownership and Control <br />2.03.4(3)(d) Names Under Which the Applicant or Principal Shareholders <br />Previously Operated a Coal Mine <br />2.03.4(4) Current, Previous, and Pending Coal Mining Permits 3-3 <br />Held by Applicant or Principal Shareholders <br />2.03.4(6)(a) Owners of Record of Surface Within the Permit Boundary <br />2.03.4(6)(b) Holders of Record of Any Leasehold Interest Within the Permit Boundary <br />2.03.4(6)(c) Holders of Record of Any Easements on the Property <br />2.03.4(7) Owners of Record of Surface Contiguous to the Permit Boundary <br />2.03.4(8) Facility Name and MSHA Number <br />2.03.4(9) Interests in Contiguous Lands 3-4 <br />Rule 2.03.5 Compliance Information <br />2.03.5(1)(a) Statement of Non -Revocation of Permit <br />2.03.5(1)(b) Statement of Bond Forfeiture <br />2.03.5(3) List of Violations <br />Rule 2.03.6 Right of Entry and Operation Information <br />Rule 2.03.7 Statement that the Proposed Permit Area is Not Unsuitable for Operations 3-5 <br />2.03.7(3) Ownership Waivers <br />Rule 2.03.8 Permit Term Information <br />RN17-05 z z Revised 12/17 <br />