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Y <br /> Operator(If Other than Permittee): Mr. Bud Tucker <br /> Permittee Representative: Alan Frantz <br /> Certified Mail# 700 o i qo 000 l jD- /5qg <br /> In accordance with Rule 4.17.1(2)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 /> Peggy L. Frantz 15645 Rd GG, Rocky Ford, CO 81067 719-254-4576 <br /> Matthew T. Proctor 982 Cedar, Rocky Ford, CO 81067 719-469-2711 <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 /> 3/22/2021 <br /> Signature of ittee, Op era r 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 /> MineralsRelemeRequ Worm Mep2017 <br /> Page 2 of 2 <br />