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Operator(If Other than Permittee): <br /> Permittee Representative: Ty Stogsdill <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 /> Katie Kirchoff 30515 County Road 3T Genoa, CO. 80818 N/A <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 /> 11 <br /> � 4/2/2025 <br /> e f P ee, Operator or 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 certif ed mail and separate from any other correspondence to the Division. <br /> MineraLsRelea eReques[Form 20Sep2017 <br /> Page 2 of 2 <br />