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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources °f' <br /> R6 <br /> <br />1313 Sherman St., Room 215 ~~ : ~. <br /> <br />~ <br />Denver, CO 80203 ~ <br />Phone: (3031866-3567 ' rave <br />FAX:1303) 832-8106 <br /> Roy Romer <br /> Goverrgr <br />ASSIGNMENT Of CERTIFICATE OF DEPOSIT Michael B. long <br /> Division Director <br />TO WHOM IT MAY CONCERN: <br />REFERENCE: Certificate of Deposit Number <br />By submission of this letter, to be attached to the above referenced <br />Certificate of Deposit, I hereby relinquish atl title and claim to said <br />certificate, except for accrued interest against the original monies, until <br />such time as the Division of Minerals and Geology/Mined Land Reclamation Board <br />releases the certificate. This assignment of Certificate of Deposit <br />supersedes any signature cards that may already be on file at the bank. <br />BY: <br />Operator/ <br />Depositor of Original Monies <br />ACKNOWLEDGEMENT OF BANK <br />NOTARY (Of Operator Signature) <br />Commission Expires <br />BY: <br />TITLE: <br />BANK NAME: <br />DATE: <br />cc: Division of Minerals and Geology <br />ATTN: Deborah Muiloy <br />1313 Sherman Street, Room 215 <br />Denver, Colorado 80203 <br />Note to Operator: <br />In the event that your bank is unwilling or unable to prepare a <br />certificate of deposit made payable only to the Mined Land Reclamation <br />Board, this assignment will need to be executed in the presence of a <br />notary with a copy provided to the bank to allow only Division of <br />Minerals and Geology access to these funds. <br />8088E (Rev. 11/92) <br />