PERMFILE120765

• Permit No: M2005039
• IBM Index Class Name: Permit File
• Doc Date: 9/28/2005
• Doc Name: PW Request
• From: DMG
• To: Bent County
• Media Type: D
• Archive: No

-3-
The provisions hereof shall bind and inure to the benefit of the parties hereto and their successors -and assigns.
SIGNED, SEALED AND DATED this day of ,
Bent County (SEAL)
Operator
By:
Title:
NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT
STATE OF )
ss.
COUNTY OF )
The foregoing instrument was acknowledged before me this day of
by
as
of
NOTARY PUBLIC
My Commission expires:
APPROVED:
State of Colorado
Mined Land Reclamation Board
Division of Minerals and Geology
sy:
Division Director
Date:
M:Min\share\bondforms\Pertonnance Wartanry.doc (052fi2004)