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<br /> ANNUAL FEE and REPORT REQUEST <br /> ?r/ <br />PERMITTEE NAME: Mine Development Inc L <br /> <br />PERMIT NO.: M-1981-165 <br />OPERATION NAME: Neglected Mine <br />ANNIVERSARY DATE: October 2, 2008 <br />ANNUAL FEE DUE: $$259.00 (Due on or before your anniversary date) <br />COUNTY: La Plata <br />RE 9- E?'? -".r <br />SEP 17 Zu'uu ?-/ <br />Division or meclamation, <br />Mining and Safety <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 />associated may. If no new disturbances or reclamation have occurred during the previous year and no <br />new changes 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: Harold E. Luzar <br />Permittee Name: Mine Development Inc <br />Address: 3319 E 4th Ave <br />Durango, CO 81301 <br />Phone Number: (970) 247-1652 <br />Fax Number: (281) 578-3159 <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 />Signature of Corpora O icer, Owner, or Designee <br />/ lb-- 049 <br />Date <br />M: \PERMIT\MASTERDOCUMENTS/M-AF-02.DOC