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'CJ <br />4~~P <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNNERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Frank Laughrey <br />M-1991-082 <br />Tiger Timber Site <br />March 17, 2005 <br />~~c~iv~® <br />JUL D 5 20~ <br />Division of Minerals and Geology <br />$281.00 (Due on or before your anniversary date) <br />Teller <br />According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator <br />shall submit the annual fee, a report and map showing the extent of current disUuhances_ to _affected_land,- -- <br />-' - reclamation accomp rs a to date and during the preceding year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />of active operations, and the date active operations ceased for the year, if any. <br />Please attach ~r revised written anmral report and annual report man to this form- Please note that an <br />adequately labeled map that clearly delineates and includes [he above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: <br />Petmittee Name: <br />Address: <br />Frank Laughrey <br />Frank Laughrey <br />P.O. Box 128 <br />Lake George, CO 80827 <br />Phone Number: (719) 748-3621 <br />Fax Number: <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />Signature of Co ora e~i6'et; 9wrter, or Designee <br />7~ ~r t75 <br />Date <br />