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?F ? Qf'-r <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: Gold Eagle Mining, Inc. <br />PERMIT NO.: M-1978-342 .? <br />OPERATION NAME: Ellison Mine <br />ANNIVERSARY DATE: February 15, 2009 <br />ANNUAL FEE DUE: $259.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />cp1? ? iD <br />PEB 100 ?Rog L-'? <br />Division or Reclamation, L? <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-aeeomplished-to-date-and-during-the-preeeding-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 changes to the previous year's map are necessary, then no new may is required, provided that the <br />O erator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may suff ce for a written report. <br />Division records. indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Coram <br />Permittee Name: Gold Eagle Mining, Inc. <br />Address: P.O. Box 3007 <br />1676 Rhine Court <br />Montrose, CO 81402 <br />Phone Number: (970) 596-2425 <br />Fax Number: (970) 249-0731 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach ' o this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />alb/?' D o ,9 <br />Date <br />M:\PERMITIMASTERDOCUMENTS/M-AF-02.DOC