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COLORADO <br /> Minerals Reclamation Permit Annual Report Division of Reclamation, <br /> Mining and safety <br /> Depm4mrertt of Naturd Resources <br /> General Information <br /> Disclaimer <br /> Under the terms of your NO[or Reclamation Permit and Colorado Statutes,you must submit Annual Fees and Annual Reports(including a <br /> map). You must pay the Annual Fee and submit an Annual Report each year until reclamation responsibility release is granted. The Annual <br /> Fee is not a renewal fee. The Fee and Report are for LAST"YEAR'S mining and reclamation season,and MUST be paid even if your <br /> operation was inactive. <br /> If you have requested reclamation responsibility release from the Division of Reclamation,Mining and Safety("Division")but your permit <br /> is not released by the anniversary date listed below,the Annual Fee MUST be paid. If the permit is released before the anniversary-date, <br /> then by Statute,it is not necessary to pay an Annual Fee or submit an Annual Report for that year <br /> Division records indicate the following is due: <br /> Select Permit Number* <br /> Only Permit Numbers with currently due Annual Reports and Fees will be listed. If nothing appears in the dropdown box below,there <br /> are no annual fees or reports due for any of your permits. <br /> M1983050 <br /> Select Anniversary Date* <br /> 04-28-2021 <br /> PLEASE REMEMBER TO CLICK"SUBMIT"AFTER YOU HAVE COMPLETED YOUR REPORT AND PAYMENT. <br /> Please check the box indicating you have read and understand the terms of the Annual Report and <br /> Annual Fee <br /> I mclerstand and agree to the terms <br /> General Information <br /> Permittee Name <br /> Phillips County <br /> Operation Name <br /> State Land-Jensen Pit <br /> Permit Number Fee Due �J oa Permit Acreage <br /> 1�1M1983050 323 -T1q 18.25 <br /> 323" Pate C�fc-�lontcs ��r?�I28Z1 <br /> County Anniversary Date Current Bond Amount <br /> Sedgwick 04-28-2021 0.00 <br />