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0 <br /> <br /> <br />i. <br /> <br />999 <br />ANNUAL REPORT <br />PERM[TTEE NAME: George E. Otten <br />PERMIT NO.: M-84-013 <br />OPERATION NAME: Mackey Mine <br />ANNIVERSARY DATE: May 14, 1999 <br />ANNUAL FEE DUE ON ANNIVERSARY DATE: $225.00 <br />COUNTY: Gilpin <br />~~ <br />MAR p 9 199' <br />...ion of ~nmerats & <br />in order to ensure that ow records are ttp to date, please attach your revised annual <br />report to this annual report. Note that a written re ftort is not necessar~if the m <br />Please type or print the current contact person's name, mailing address, and phone <br />provided: <br />Contact Name: Corripany:, <br />Address:: Phone No.: <br />Fax No.: <br />//~ ~ <br />map and written <br />in the space <br />Signat re of Corporate Officer, or Owner <br />Date <br />INSTRUCTIONS ON BAC'% <br />~~~ <br />Al \DNRA11N1ASTERDU1-AF-01. <br />