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STATE OF COLORADO <br />DIVISION OF MINERALS AND GEOLOGY <br />Department of Natural Resources <br /> <br />1313 Sherman St., Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br /> <br />E`E/Vp <br />? <br /> <br />DEC' ' <br />?fir <br />VVV <br />DIY%Slpp p/ <br />Minerals an <br />d Geelpgy <br /> <br />u vision or <br />MINERAL S <br /> <br />GEOLOGY <br />R E C L A M A T I 0 N <br />r.tNiNG•SAFETY <br /> <br />Bill Owens <br />Governor <br />ASSIGN-NIEt OF CERTIFICATE OF DEPO IT Greg, E. Walther <br /> Executive Director <br /> michael B. Long <br />TO WHO IT MAY CONCERN: Director <br />REFERENCE: Certificate of Deposit Number o20 00S <br />By submission of this letter, to be attached to the above referenced Certificate of Deposit, I hereby relinquish all title <br />and claim to said certificate to the State of Colorado/Mined Land Reclamation Board, except for accrued interest <br />against the original monies, until such time as the Division of Minerals and Geology/Mined Land Reclamation Board <br />releases the certificate. This assignment of Certificate of Deposit supersedes any signature cards that may already be <br />on file at the bank. <br />BY: <br />Signature <br />Operator: / ,1 rkS <br />Depositor of Original Monies <br />ACKNOWLEDGMENT OF BANK <br />SIGNATURI? <br />TITLE!- (-? <br />DATE: Q- ?a- Cpl-) <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 />NOTARY (Of Operator Signature) <br /> <br />Co xpire?nT <br />12-1 LIG <br />STATE OF ARIZONA <br />Mohave County <br />W. LORRAINE DOUGLAS <br />My Commission Expires November t t ,2004 <br />This assignment forln will need to be executed in the presence of a notary. The original is held by the Division with a <br />copy provided to the bank to allow only the Division of Minerals and Geology access to these funds.