My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
REV93083
DRMS
>
Back File Migration
>
Revision
>
REV93083
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
8/25/2016 3:14:26 AM
Creation date
11/21/2007 11:27:24 PM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1981068
IBM Index Class Name
Revision
Doc Date
4/29/1993
Doc Name
TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS APPLICATION FORM
Type & Sequence
SO1
Media Type
D
Archive
No
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
5
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
, I aPR ~s • 9a <br />_j~~~~ <br />7o~saarl nr~'~IraCn~scEC III'II'll'll"II III . • P.a~sJ <br />STATE OF COLORADO <br />OF MINERALS AND GEOLOGY <br />~r or Natural Resources <br />~ I 1713 Sherman Sc. Room 215 <br />Denver, CO 60703 <br />~ Phone: 13U3i dGG•li8? <br />F.1x: ~3U316J 7.8106 <br />P c0 <br />RECEIVED ~~~~ <br />M:" <br />r8 5 ~ <br />APR 29 1993 '~^~~' ~ <br />RoY Ramer <br />GO•'bnOr <br />Division ei M~nera'~s ~ iieoloyy Mlchaal B. LOnp <br />TRANSFER Df P£RMIT AND SUCCESSION OF OPERATORS oi.~s~on 9~recio. <br />APPLICATION FORM <br />hR application for a Transfer of Permit and Successipn of Operators must contain four <br />4) ma3or parts: 1) an Application Form; 2) an Application fee; 3) a Performance <br />arranty (attached as part of the Application Package) bearing the original notarized <br />i9nature of the Successor Operator; and, 4) a replacement Financial Warranty provided <br />y the Successor Operator, bearing an original notarized signature. To expedite <br />rOcessing, please provide the information in the format and order described below. <br />ADMINISTRATIVE INFpRh4ATI0N <br />Permit Number: <br />2. Operation Name: <br />3, Current Permitted Operator: <br />Contact Person; <br />Company Name: <br />Street: <br />City: <br />State: <br />Area Cvde; <br />4. Successor Operator: <br />Contact Person: <br />Company Name: <br />Street; <br />City: <br />State: <br />Area Code: <br />IRS Tax ID No. or Social <br />M-81-loC-S <br /> <br />l~E-s~av+~ -~o~11G A./sr'E-R~,•q ~,rJC <br />pnno Doy ~ )s88 <br />UG W a1 Cr C, O <br />~ © ~ Zip Code: 80eta.1-,27~.~.5' <br />303 Telephone: a2lo- <br /> <br />G~a.~ -E Gros Cc,ns'1' 1.'t'A ~,a6,) fyCo.+a~a~~ <br />Pd a®~ ro a~ <br />AA:o,lt ' <br />Go Zip Code: 8/L~l <br />303 Telephone: 9~ ~-3~0/ <br />Security No.: `~ 4- 1L7.20~~{ <br />5, Application Fee: $100.00 <br />Make Check payable to the Division of Minerals and Geology <br />N~.~.- Nv <br />
The URL can be used to link to this page
Your browser does not support the video tag.