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RECEIVED <br />APR 0 3 2003 <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Jerald Seifert and Fred Lowry <br />M-1999-003 <br />Tallahassee Pit <br />Apri18, 2003 <br />$281.00 (Due on or before your anniversary date) <br />Fremont <br />Division of Minerals and Geology <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 disturbances to affected _ land <br />rec amatton accomp tshe 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 ynnr revised written annual rennrt and annual report m ~ to this form. Please note that an <br />adequately labeled map that clearly delineates and Includes the above a/ements 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: Mary Seifert <br />Permittee Name: Jerald Seifert and Fred Lowry <br />Address: P.O. Box 305 <br />Westcliffe, CO 81252 <br />Phone Number: (719) 783-2757 <br />-Fax Number: - (719) 783-2988 <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 o orpor to Offie~ner, or Designee <br />-~ f -o <br />Date <br />M:IPERM ITU1ASTERD000MENTSIM-AF-01 <br />