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Operator (If Other than Permittee): <br />Permittee Representative: Laura L. SChroetlin <br />Certified Mail # 70160910000126932900 <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 <br />Address <br />Phone Number <br />Christopher Mattson 40235 Co Rd 31, Holyoke, CO 80734 970-854-2602 <br />Anthony Mattson 10504 San Marino Ave, Albuqerque, NM 87111 unknown <br />Austin Tharp 27474 Co Rd 44, Ovid, CO 80744 unknown <br />Frank Austin 01447 Co Rd 29, Ovid, CO 80744 970-854-2511 <br />Winston & Mary Ham Irrevocable Income Only Trust 715 S Fairview Ave, Haxtun, CO 80731 970-774-6573 <br />Troy Anderson 9681 Co Rd 42, Haxtun, CO 80731 970-774-6531 <br />t <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 o Permittee, Operator or their authorized agent <br />�ov on 6, Z0(,Z°7,( <br />Date <br />Important: In accordance with Rules 4.14.2(a) and 4.17.10) This release request must be submitted to the <br />Division via certified mail and separate from any other correspondence to the Division. <br />MinmisReleweRequestFom 20Sep2017 <br />Page 2 of 2 <br />