PERMFILE47909

• Permit No: M1995023
• IBM Index Class Name: Permit File
• Doc Date: 6/8/1995
• Doc Name: Bond Instruction Letter
• From: DMG
• To: FIRST NATIONAL BANK
• Media Type: D
• Archive: No

• PERMI7 N0.
STATE OF COLORADO
DIVISION OF MINERALS AND GEOLOGY
Depanmeni of Natural Resources ASSIGNMENT OF CERTIFICATE OF DEPOSIT
1313 Sherman St., Room 215
Denvcr, Colorado 80203
Phone: [phone]
FAX: [phone]-B 106
TO WHOM IT MAY CONCERN
REFERENCE: Certificate of Deposit Number
~~~~
DEPA[iTMENT OF
NATURAL
RESOURCE
Roy Romer
Governor
lames 5. Lochhead
By submission of this letter, to be attached to the above referenced cRec°"veofre"°`
Certificate of Deposit, I hereby relinquish all title and claim to said Michaele LOng
certificate, except for accrued interest against the original monies, to the ~"'S1On oirec~or
State of Colorado/Mined Land Reclamation Board until such time as the Mined
Land Reclamation Board releases the certificate. This assignment of
Certificate of Deposit supersedes any signature cards that may already be on
file at the bank.
Authorized Signature:
Print Name:
Operator Name:
Depositor of Original Monies
ACKNOWLEDGMENT OF BANK
By: _
Title:
NOTARY (of Operator Signature)
Commission Expires
Bank Name:
cc: Mined Land Reclamation Division
Attn: Deborah Mulloy
1313 Sherman Street, Rm 215
Denver, Colorado 80203
Note to Operator:
In the event your bank is unable to prepare a certificate of deposit made
payable only to the Mined Land Reclamation Division, this assignment will
need to be executed in the presence of a notary with a copy provided to
the bank to allow only Mined Land Reclamation Division access to these
funds.
Doc. No. 8088E

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