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<br />-5- <br /> <br />5. The additional stipulations set forth in the attached rider, <br />if any, are incorporated herein by reference. <br />/XX/ a) Rider is attached. <br />/ / b) No rider is attached. <br />ACCEPTED AND AGREED: DIVISION OF MINERALS AND GEOLOGY <br />COLORADO DEPARTMENT OF <br />NATURAL RESOURCES <br />By <br />Operator Title Division D ector <br />STATE OF )ss <br />COUNTY OF > <br />The foregoing instrument was acknowledged before me this day of <br />19_ by <br />as of <br />operator. <br />NOTARY PUBLIC <br />My Commission expires: <br />3150G <br />