Laserfiche WebLink
TATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />ASSIGNMENT OF CERTIFICATE OF DEPOSIT <br />COLORADO <br />D I V I S ION OF <br />MIN ERALS <br />GEOLOGY <br />RECLAMATION-MINING <br />SAFETY-SCI ENCE <br />Bill Owens <br />Governor <br />TO WHOM IT MAY CONCERN: <br />REFERENCE: Certificate of Deposit Number 8913333616 <br />Greg E. Walcher <br />Executive Director <br />Ronald W. Cattany <br />Division Director <br />Natural Resource Trustee <br />By submission of this letter, to be attached to the above referenced Certificate of Deposit, I hereby relinquish all title and <br />claim to said certificate to the State of Colorado/Mined Land Reclamation Board, except for accrued interest against the <br />original monies, until such time as the Division of Minerals and Geology/Mined Land Reclamation Board releases the <br />certificate. This assignment of Certificate of Deposit supersedes any signature cards that may already be -on- fi-le. <br />BY <br />Signature <br />Operator: Dick Casey Concrete, Inc. <br />Depositor of Original Monies <br />ACKNOWLEDGMENT OF BANK: <br />Signature: <br />t'/??7&2 lr.? <br />BY, Lillian L. Dahlin <br />TITLE: Vice President <br />DATE: y7 l1( 10 <br />Return Original Form to: <br />Note to Operator: <br />Division of Minerals and Geology <br />1313 Sherman St., Rm 215 <br />Denver, CO 80203 <br />?",pPH N <br />This assignment form will need to be executed in the presence of a notary. The original is held by the Division with a copy <br />provided to the bank to allow only the Division of Minerals and Geology access to these funds. <br />M:Vsrin\sbareVwndfon=VAlassig form.bnddoe <br />REVISED 02114/02 <br />NOTARY (Of Operator Signature) <br />Commission Expires I <br />,,_Ili ?` <br />Office of Office of Colorado <br />Mined Land Reclamation Active and Inactive Mines Geological Surve