REP46850

• Permit No: M1993059
• IBM Index Class Name: Report
• Doc Date: 9/21/2005
• Doc Name: Annual Report Packet
• From: DMG
• To: Midwestern Farms Resource
• Media Type: D
• Archive: No

ANNUAL FEE and REPORT REQUEST
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUN"I'Y:
Midwestern Farms Resource
M-1993-059
MIdwestern Farms
March 4, 2005
$688.00 (Due on or before your anniversary date)
Prowers
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 shall submit the annual fee, a report and map showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to
occur during the upcoming year, reclamation 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 annual report and annual resort man to this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: James H. Kirkland
Permittee Name: Midwestern Farms Resource
Address: P.O. Box 580
Phone Number:
Fax Number:
Rye, CO 81069
[phone]
[phone]
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 instmctions are enclosed.
Signature of Corporate Officer or Owner
Date