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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman SL, Room 215 ~ ~ r` ~ + 1; { ~ S'1 <br />4 C O L O RA D O <br />(3enVQ(, GOlOfadp a0203 _ D{ Y I S I O N O F <br />Phate: (30318663567 MINERAL S <br />FAx: 1303)832A106 ~ ~ ~/~1 7 <br />~~Ir~~i O.) (li~l GEOLOGY <br /> OiYnlon e(?<•.Jr;~= ~~;iQm, RFCLANAiION•N IN IN6 <br />[ArETY4C1[N C[ <br /> hhiring e::C Safa,y <br /> ein owem <br /> TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS Governor <br /> APPLICATION FORM Ru[seu George <br />EAecutive Director <br /> Ronald W. Canany <br /> Division Director <br /> Natural Resource Tmstee <br />The application for a Transfer of Permit and Succession of Operators must contain four (4) major parts: 1) an Application Farm; 2) <br />an Application Fee; 3) a Performance Warranty (attached as part of the Application Package) bearing the original notarized <br />signature of the Successor Operator; amd, 4) a replacement Financial Warranty provided by the Successor Operator, bearing an <br />original notarized signature. To expedite processing, please provide the information in the foment and order described below. <br />FINANCIAL WARRANTY INFORMATION (Choose ONE Ootioal: <br />1.0 do i wish to WAVE MY RIGHT to a 30-day processing time to allow the <br />(Initial & Date) Division of Minerals and Geology [o recalculate the Financial Warranty <br />requirements. If you choose Option A you should not subadt a Financial <br />Warranty and Performance Waranty lentil the Division notifies you of the <br />cored slnount of your waranty requirements.* <br />2.Ontion B: I DO NOT WISH TO WAIVE MY RIGHT to a 30-day processing time. I <br />(Initial & Date) hereby submit a replacement Financial Waranty fox the satne dollaz atnount <br />as the Financial Waranty maintained by the current operator. I understand <br />that the Division of Minerals and Geology will recalculate the required <br />reclamation bond within 60-days from the date that the transfer is completed <br />and the required FINANCIAL WARRANTY COULD BE <br />SUBSTANTIALLY INCREASED at that time. Aa the new operator, I agree <br />to be responsible for posting any required increase to the financial warranty <br />fox good cause shown, in a form acceptable to the Board, within GO-days of <br />such notice. <br />~~~ = /~~ <br />'' / D~~ 3 200 ~ <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inagive Mines Geological Survey <br />