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-7- <br /> /X / 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 Director <br /> STATE OF ) ss <br /> COUNTY OF ) <br /> The foregoing instrument was acknowledged before me this day of 19 by <br /> as <br /> of operator. <br /> NOTARY PUBLIC <br /> My Commission expires: <br />