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Operator(If Other than Pernuttee): <br /> Permittee Representative: �aCOb �eCOtO <br /> Certified Mail# . <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 /> Atticus Land, LLC PO Box 88010, Colorado Springs, CO 80908 2�6-419-4533 <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 /> l � ��"�� <br /> 31 ) � �,��.�---v <br /> Signature of Permitt�e, Operator eir authorized agent Date <br /> Important: In accordance tivith Rules 4.14.2(a) and 4.17.1(3) This release y�e�rerest must be sirbn�itted to the <br /> Division via ce��ti�ed mail and separ•ate fron� am�othe��cor•respondence to the Division. <br /> MmeralsRrleaseRequrc�Form 2USep2U 17 <br /> Page 2 of 2 <br />