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NOTARY FOR PROSPECTIVE SUCCESSOR <br /> STATE OF ) <br /> ss.: <br /> COUNTY OF ) <br /> The foregoing instrument was acknowledged before me this day of , <br /> by as of <br /> Notary Public <br /> My Commission Expires <br /> STATE APPROVAL <br /> [for completion by Division] <br /> (a) The Board hereby approves the transfer of permit number from <br /> to <br /> (b) The Board hereby recognizes as Successor Operator under <br /> such Permit. <br /> (c) The Board hereby accepts the Performance and Financial Warranties submitted by Successor and hereby <br /> releases ,as former Permittee from all obligations under <br /> its Performance and Financial Warranties. The Board further releases all affected financial warrantors from <br /> obligations under Financial Warranties associated with the former Permittee. <br /> STATE OF COLORADO <br /> DEPARTMENT OF NATURAL RESOURCES <br /> MINED LAND RECLAMATION BOARD <br /> DIVISION OF RECLAMATION,MINING AND SAFETY <br /> By: Date Executed: <br /> Division Director <br /> - 10 - <br />