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STATE OF COLORADO <br />DIVISION OE MINERALS AND GEOLOGY <br />Department o(Natural Resources <br />1373 Sherman St., Room 215 <br />Denver, Colorado 80203 DIVISION O F <br />Phone: (303) 866-3567 ~ MINERAL $ <br />FAX: (303) 832-8706 & <br /> GEOLOGY <br /> 0.ECLAMATION <br /> MI NING•SAFE7Y <br />ASSIGNMENT OF CERTIFICATE OF DEPOSIT <br /> Bill Owens <br /> Governor <br />TO WHOM IT MAY CONCERN: dreg E. watcher <br /> Executive Director <br />REFERENCE: Certificate of D 2t NUmI)er <br />el)OS Michael 6. Long <br />Division Director <br />By submission of this letter, to be attached to the above referenced Certificate of Deposit, I hereby relinquish all title and <br />claim to said certificate to the State of Colorado/Mined Land Reclamation Boazd, except for accrued interest against the <br />original monies, until such time as the Division of Minerals and Geology/Mined Land Reclamation Boazd releases the <br />certificate. This assigliment of Certificate of Deposit supersedes any signature cazds that may already be on Ste at the bank <br />BY: <br />Operator: <br />ACKNOWLEDGMENT OF BANK: <br />SIGNA'T'URE <br />BY: <br />TITLE: <br />DATE: <br />Return Original Form to: Division of Minerals and Geology <br />1313 Sherman St., Rm 215 <br />Denver, CO 80203 <br />Note to Operator: <br />Signature <br />Depositor of Original Monies <br />NOTARY (Of Operator Signattre) <br />Commission Expires <br />This assignment form will need to be executed in the presence of a notary. The original is held by the Division with a copy <br />provided to the bank to allow only the Division of Minerals and Geology access to these funds. <br />n+:t~~ns~m~are,ffi~aa=s+~~noa.ao~ <br />xevrsEDOVtaoz <br />