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-Ai:7 + R--r <br />ANNUAL FEE and REPORT REOUESnST RECEIVED <br />Yv <br />PERMITTEE NAME: Midas Mining Company, Inc. AUG '18 2004 c/ <br />PERMIT NO.: M-2001-063 c/ Division oT Keclamation, <br />Mining and Safety <br />OPERATION NAME: Ophir Lode <br />ANNIVERSARY DATE: September 23, 2008 <br />ANNUAL FEE DUE: $$259.00 (Due on or before your anniversary date) <br />COUNTY: Hinsdale <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-andmap 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 />associated map. If no new disturbances or reclamation have occurred during the previous year and no <br />new chances to the previous year's map are necessary, then no new map is required. provided that the <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: Wayne R. Giesy <br />Permittee Name: Midas Mining Company, Inc. <br />Address: P.O. Box 772 <br />Philomath, OR 97370 <br />Phone Number: (541) 929-4170 <br />Fax Number: (541) 929-4174 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />elow or attach it to this form along with your written report and map. Annual Report instructions are <br />/enclosed. &6 A/P-Qr cf -, 4,4vba-1-,w v? 2?o/Q? ef??h ?avL csceUr<.r? dw?.ry t/st?r?wB?j?t <br />/9 ?4a <br />Signature o Corporat Officer, Owner, o esignee <br /> <br />Date <br />M:PERMITIMASTERDOCUMENTS/M-AF-02. DOC