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IVISION OF MINERALS AN <br />Department of Natural Resources <br />1111 Sherman SL, Room 215 <br />Denver, Colorado RO203 <br />Phone: (303) A66-3567 <br />FAX: ISQSI B32-R106 <br />AUG 2 4 1998 <br />r~oFCc <br />RECEIVED <br />AUG 1 31998 <br />DIV. OF MINERALS <br />& GEOLOGY <br />ASSIGNMENT OF CERTIFICATE OF DEPOSIT <br />Ruy Romer <br />Governor <br />lames 5. Lochhead <br />TO WHO IT MAY CONCERN: rxecu6.~0o-ecror <br />Michael B. Lonq <br />Division Director <br />REFERENCE: Certificate of Deposit Number ~a~p~ of ~j/~ ~ <br />By submission of this ]ever, to be attached to the above referenced CerdFcate of Deposit, I heroby reiu)quish ali <br />title attd claim to said certificate to the State of Colorado/Mined Land Reclamation Board, except for accrued <br />interest against the original monies, until such time as the Division of Minerals and Geology/Mined Land <br />Reclamation Board releases the certificate. This assignment of Certificate of Deposit supersedes any signature <br />cards that may already be on file at the bank. ~~~ ~. <br />~ACKNOWI.EDGMENTOF BANK..I <br />SIGN <br />BY: <br />TITL <br />DATE: ~ U_ '1~~_ w' 7 f1 <br />Operator: DA~Uid L. (.tJFI/Ke1C <br />Depositor of O~r~iginal Moni~~eyys~~,,,,..~ 1~ <br />.~. ° ~,~ <br />NOTARY (Of Operator Si~natu ), ~ o o ~ <br />~GOmn'NSSiT1 r!.rp.t.tM _//~~ / <br />Commission Expires ~ (zLP 1 c~-- <br />Christine Vine, Notary Public <br />State of Colorado <br />My Commission Expires 5128120!)2 <br />Return Form to: Division of Minerals and Geology ~- ,;~;; •• uNOA J. aw+ <br />~ e ri'K, rr tottwlssloe ~ ce stew <br />1313 Sherman St., Rm 215 a~ - E~wrs: wre n, aom <br />Denver, CO 80203 •1 ,,, ~TMUNOtlnP'm'p1hi0in"""' <br />Note to Operator: <br />This assignment form will need to be executed in the presence of a notary. The original is held by the Division with <br />a copy provided to the bank to allow only the Division of Minerals and Geology access to these funds. <br />- - . ~~ <br />C90FFICEI W P W IN1 W PDOCSIASSIGNFM. W PD <br />