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IVISION OF MINERALS AND GEOLOGY <br />Department of Nawral Resources FEB 2 0 2003 <br />1313 Sherman St., Room 275 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 Division of Minerals and Geology <br />FAX: (303) 832-8106 <br />ASSIGNMENT OF CERTIFICATE OF DEPOSIT <br />~~ <br />DIVISION O <br />MINERAL <br />GEOLOG' <br />REC LAMATI (jF <br />M ININ G~SAFET <br />Bill Owens <br />Governor <br />TO WHOM IT MAY CONCERN: <br />REFERENCE: Certificate of Deposit Number <br />4285071778 <br />Greg E. Walther <br />Executive Director <br />Michael B. 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 Board, except for accrued interest against the <br />original monies, until such time as the Division of Minerals and Geology/Mined Land Reclamation Board releases the <br />certificate. This assignment of Certificate of Deposit supersedes airy signature cards that Wray already be on file at the bank. <br />BY: ~~ a ~~,, <br />Signature <br />operator: /,/i ~.rr~~,-n ~/oo,oGly~rs~,C6 <br />Depositor of Original onies <br />ACKNOWLE MENT OF BANK: <br />~ ~ ~~ <br />SIGNATURE <br />BY: ~. ~II~N ~h~o~m <br />TITLE: a~ O{~ Sr) ~~I I I,~f~~~-' <br />DATE: ~_I ~ " ~ 3 <br />Return Original Form to: <br />Note to Operator: <br />Division of Minerals and Geology <br />1313 Sherman St., Rm 215 <br />Denver, CO 80203 <br />NOTARY (Of Operator Signature) <br />Commission Expires ~ _O <br />... . <br />~':• <br />Lv. ••. TUBLIG <br />ExPisee <br />v1 <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 />