REP10965

• Permit No: M1991082
• IBM Index Class Name: Report
• Doc Date: 3/17/2004
• Doc Name: 2004 Annual Report
• From: Frank Laughrey
• To: DMG
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

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RECEIVED
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
Frauk Laughrey
M-1991-082
Tiger Timber Site
March 17, 2004
$281.00 (Due on or before your anniversary date)
Teller
MAR 17 2004
Division of Minarais & OoeIODY
According to C.R.S. 34-32.5-116 or C.R.S. 34-32-I 16, each year, on the anniversary date of the permit, an operator
shall submit the annual fee, a report and map showing the extent of cun•ent disturbances to affected Land,
-teclamatiari accamplished-to-date-and-during the-preceding-year,-neiv-disturbances-that-ar~anticipated_to_occur- _
during the upcoming year, rec]amation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach your revised written annnal rennrt and annnal report man to this form- Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Frank Laughrey
Permittee Name: Frank Laughrey
Address: P.O. Box 128
Lake George, CO 80827
Phone Number: [phone]
Fax Number: - -
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions aze enclosed.
~ ~ ~~
Signature of Corporate Officer, Owner, or Designee
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Date