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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />,~ ~ ,~ P i <br />ANNUAL FEE and REPORT REQUEST <br />/ Indian Creek Mining Corp. <br />~-1991-054 <br />Profitt <br />May 29, 2007 <br />s va-~ <br />.. <br />~ 1 1 ~tl(TI <br />~~ <br />.~ <br />~:.~, <br />$$75.00 (Due on or before your anniversary date) <br />Saguache <br />AccQrding_tc~.C_R_S__34-3~,5~ 16 or_C.R.S_34_32-L16,_eaohyear, on_the anniyersary_date of the permit, an _ _ _ _ . __ _ <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />]and, reclamation accomp]ished to date and during the preceding year, new disturbances that are anticipated to <br />occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written annual report and annual resort map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the nrevious year and no <br />new chances to the nrevious year's man are necessary, then no new map is required, provided that the <br />O~terator shall state this in the Anneal Report. Please note that an adequately labeled map that clearly <br />delineates and includes the 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: Don Flickinger <br />Permittee Name: Indian Creek Mining Corp. <br />Address: Box 350 <br />Phone Number: <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 <br />enc sed. <br />Signature of Corporate Offi r, Owner, or Designee ~O ~ ~ <br />~~ <br />Date <br />Kodiak, AK 99615 <br />(719) 655-2225 <br />M:iPERNlrIMASTERA7CUMENfSMf-AF-02.DOC <br />