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IIIIIIIIIIIIIIIIIII ~ RECEIVED <br /> <br />U.S. DEPARTMENT OF AGRICULTURE 999 <br />i <br />F <br />S <br />F E B 2 4 ~ g 8 3 <br />erv <br />orest <br />ce <br />RECLAiVI~-TiOM PERrORfV1A1VCE ~l~ RECLAMATION <br />IA1inerals Operating Plan and/or Exploration Permit, InCUding Geother6OlD. DFPT. OF NATURAL RESOURCES <br />' (Reference FSM 6506) <br />INSTRUCTIONS: (1) This Corm is authorized for use whenever a Pertormance Bond is required in connection with National Forest <br />Reclamation .-lctivity. (2) The (tilt legal name and Business address of the Principal shall be Inserted in the space designated 'Principal' <br />on the face of this form. The bcr.d >hall be signed by m authorized person. Where such person is signing N a representative capacity <br />(e.g., an attorney-mlact), bet ~s not a member of the firm, paanership, or joint venture, or an officer pf the corporation involved. <br />.endence of hu au thonty must be famished. (3) Corporations executing the bond as sureties must be among Ihase appearing on the <br />Treasury Department's list of approved sureties and must be acting within the limitauens sit forth therein. (4) Cerporations executing <br />the bond shall affil their corporate seals. Individuals shall execute the band opposite the work 'Seal', arid, If exeuuted in .Maine or Ne•.v <br />Hampshire. shall also affix an adhesive scat (5) The name of each person signsng this bond should be typed in the space provided. <br />Pnnupal /Legal name end wa;ness address/ Dale Bond Executed <br />Westley F, and James Potts <br />2 Type of Organization (X Appropriate Bor/ <br />Rt ~ <br />Mancos, CO 81328 <br />^ Individual <br /> <br />a Partnersh iP <br />Ir <br />Joint Venture <br />Surery6esl (A'ame/rl and business address/esJJ <br />Corporation <br />Mancos State Bank <br />PIanCOS, CO 81328 State of Incorporation <br />PENAL SUM OF 80ND <br />Mdlipnls) S Thpusandlsl S Hendren lsl S <br />rive <br />KNOW ALL \1EN BY THESE PRESENTS, That we, the Principal and Sure tylies~ here [o. are I:rtn lS' bound to the United Stites of <br />Amcaca (he: e;nalter called the Government/ m the above penal sum fnr the payment nl whsch we hind ourselves, and tech of nor heus, <br />executers, adm mstrators, and successors, jointly and severally: Prosided. That, where the Sure Ues .tie corporations acting as co-sureties. <br />we, the Sureties, bind ourselves In such sum 'iomtly and severally' ss well as 'saver:dJ y' only for the pumose of allowing a /Dint attion or <br />actions agarnsr any or all of us, and for all tither purpmes each Surety bends itself, loinity and severally with the Principal, for the pay- <br />ment of such >um only as is set lor[h opposite :he name of such Surety. but d no limit pt habdity is indicated, the Ismit of liabduy <br />mall be the IuB amount ul the penal sum. <br />SCHEDULE OF OPERATING PLANS ~ REGION Z <br />Name of Pere ung Amount Allowtatl Amount of Allpca led Date Unalloca[etl <br />National Forest Plan Date to Operating Plan Restored gestored Balance <br /> Nvmber IS) 151 ISI <br />San Juan 11/2/8 $500.00 <br /> <br /> <br /> <br /> <br /> <br /> <br />FS~6500.7 (5/791 <br />