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<br />PI.It~11ITPI \,1~If' fhornbur~ Family Limited Partnership ~:`'~ •~ 3 ~~~5
<br />Plilt~lll ~u,: M1l-I9R3-On0 ,
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<br />UI'I RA l p)V r\,\~II 1'hurnburt; Pil
<br />:1VNIV1'R4\R1' I):\ I I ticptemhcr 2'• 2110(r
<br />:1N\L:11 111 1)I'I. R6AS.Of1111ueonorlu•fnresourunnisersundulcl
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<br />:1cc++rding t„ C'.R.1, ~-I-t_,j_I Ib „r l .R.ti. 3d-+'-I 16. cad, yrar, un thc:umi,cr,;rn Jalc.,f the permit. un operator
<br />,hull ,uhmn the annual Ice, n rclx,n and map ,ha„ing the cztcnt of currcnl Ji,wrhancc, t„ affcctcJ land.
<br />roclam;niun accomplished n, d:ne .mil during thr prreeJing year. nea Jrauuhuncr, that are amicipalrJ n~ i+:iur
<br />JunnL the upuxnin~ year. rcclantanon th:u „ill he ixrli~rnte.l donne dtc cnminc }car. tlic d;nr, bo the hccuunn
<br />ofaclisc niwrutiun,. and the date ucti~c,q,crati,•n: ira,rJ Inc Ihr yc:u. If am.
<br />Pleuxt• attach your rc, isrd ,~ ritlen annual report anJ annual report map h, this form. I he Annual Report
<br />.~ Fee requirement is not met until ,se haeo reccised the folloein~ cumponenh: fee, repurt.:urd us,ociuled
<br />n~i 1,\II arc required re{;ardlrs of the Icscl ut•Jivhrrb:ur.•r nr absence of di,un'b:urce dur•inL the pre, ion,
<br />ycnry. I'Ic~ni :u~1r llr~rr,rn:rdrgl:~r1~1, h:hrlrrl nnq~ Ilan ~lr;mh J~~hnr,Nr, ~nul nr~ irelr, lin ;r!,~„~, rl,ni, w. glut
<br />Ui,i,um records indicate the ti>Ilu,sing pcrrnittec contact inR,rmation. Place serilj and nuti,r ^nq neccs;:trv
<br />chances:
<br />I'enniltcc ll+nluct: tit:utley I hanthurg
<br />I'CI'nilllCC ~:nne', fhornhurg Tamil, I imitcd Partnership
<br />ficnnctt. ('(t 81110_
<br />Phone humhcr. 1?0316d-1-i.i'_4
<br />I as Vunll+cr
<br />It' you ha~c uddiuonal comments and'„r udunnatiun that should be procidcd ti, the I)ivurm, plc;nc pnnrde n
<br />hrlnw or:nurch it t„ Ihi, forrn:dunc with your wr•nlen rcix,n anJ mop Annual Rcpnn in,tntctiun, arc cnclox•J
<br />Signuuuc of t'orp,+ralr t 1liierr, l ),sncr, or I)c,ignec
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