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STATE 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 iov <br />FAX: (303) 832-8106 <br />DEPARTMENT OF <br />NATURAL <br />RESOURCES <br />ASSIGNMENT OF CERTIFICATE OF DEPOSIT Roy Romer <br />Governor <br />James S. Lochhead <br />TO WHOM IT MAY CONCERN: Executive Director <br />Michael B. Long <br />Division Director <br />REFERENCE: Certificate of Deposit Number ?IS?d <br />By submission of this letter, to be attached to the above referenced Certificate of Deposit, I hereby <br />relinquish all title and claim to said certificate to the State of Colorado/Mined Land Reclamation Board, <br />except for accrued interest against the original monies, until such time as the Division of Minerals and <br />Geology/Mined Land Reclamation Board releases the certificate. This assignment of Certificate of <br />Deposit supersedes any signature cards that may already be on file at thS*nk. A <br />BY ?/ Gam- <br />Operator/d/?Z, <br />ACKNOWLEDGEMENT OF BANK <br />BY: ` 7 <br />TITLE: _ <br />BANK N <br />DATE: <br />cc: Division 6f Minerals and Geology <br />ATTN: Deborah Mulloy <br />1313 Sherman Street, Room 215 <br />Denver, Colorado 80203 <br />Depositor of Original Monies <br />NOTARY (Of Operator Sig ure) <br />Commission Expires !!Z-2V, 91*1 <br />oPRIGAL SEAL <br />912!1h CLAUMDODGE <br />Pdjft-SMdAftW <br />va <br />COUNIT <br />Ir took" BOB Am X ? <br />Note to Operator: <br />In the event that your bank is unwilling or unable to prepare a certificate of deposit made payable <br />only to the Mined Land Reclamation Board, this assignment will need to be executed in the presence <br />of a notary with a copy provided to the bank to allow only Division of Minerals and Geology access <br />to these funds. <br />5633F.bnd <br />REVISED 6/%