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ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bluerock Energy Corporation <br />M-2005-050 <br />J Birds <br />Apri119, 2008 <br />$$259.00 (Due on or before your anniversary date) <br />Montrose <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 <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 your 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, report, and <br />Operator shall state this in the Annual 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: Stephen E. Glass <br />Permittee Name: Bluerock Energy Corporation Bluerock Energy Corporation <br />Address: 36 West Main Street 10 West Main St . <br />Suite 110 <br />Cortez, CO 81321 Cortez, CO. 81321 <br />Phone Number: (970) 739-8392, 9 7 0- 5 6 4- 9 6 4 6 <br />Fax Number: 970-564-9612 <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 />-~ <br />- ~9~ <br />Signa rporate Officer, Owner, or Designee <br />Date <br />M.• I PERMI71 MASTERDOCUMENT S/M-AF-02. DOC <br />