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PF ~-. ~~ <br />ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: Mount Royale Ve <br />ntures, LLC ~ REC~ <br /> <br />PERMIT NO.: / <br />M-1983-141 ~,/ n f~ <br />"" <br />OPERATION NAME h & Wh <br />D <br />Mi <br />C ~ 7~~®~ <br />: nes <br />as <br />o <br />o Divl ~ <br />ANNIVERSARY DATE t <br />7 <br />2007 <br />S <br />b ~~~ <br />~ <br />: ep <br />em <br />er <br />, y <br />~°'~Y <br />ANNUAL FEE DUE: $$259.00 (Due on or before your anni versary date) <br />COUNTY: Boulder <br />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 <br />_ operator shall submit the annual fee,,a report and map showing the extent of current disturbances to affected _ <br />land, reclamation accomplished 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 vour revised written annual report and annual report map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, resort, and <br />associated map. If no new disturbances or reclamation have occurred during the previous vear and no <br />new chances to the previous year's map are necessary, then no new map is required, provided that the <br />Operator shall state this in the Anneal Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suffice for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: R T. Heard <br /> MA-t~ C~t~-tti S <br />Permittee Name: Mount Royale Ventures, LLC --> <br />Address: P.O. Box 19754 <br /> Boulder, CO 80308 -' <br />Phone Number: (303) 517-3740 <br />Fax Number: (720) 565-3497 <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 />enclosed. <br />Signat i~ o Cor 'ate Ofticer, Owner, or Designee <br />~~~/~ <br />Date <br /> <br /> <br />M:~PERMI7IMASTERDOCUMENTS~M-AF-02.DOC <br />