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+ KQ <br />ANNUAL FEE and REPORT REOUEST <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Bachelor Silver Mines Company <br />M-1980-170 L/ <br />Bachelor Mines <br />March 25, 2009 <br />$259.00 (Due on or before your anniversary date) <br />Ouray <br />0:.... coy, J" <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 />`-lancl,-recl-amation accomplished-to-date-and -duringtiie-pree-edingyt ar, n-ew-disturbatrceTtliat we antic pated-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 may 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 chances 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: Carl F. Dismant <br />Permittee Name: <br />Address: <br />Phone Number: <br />Fax Number: <br />If you have <br />below <br />L• <br />Bachelor Silver Mines Company <br />P.O. Box 965 <br />Ouray, CO 81427 <br />(970) 325-4665 <br />1 <br /> <br />&I--- <br />comments and/or information that should be provided to the Division, please provide it <br />is form along with your written report and map. Annual Report instructions are <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M:PERMITIMASTERDOCUMENTS/M-AF-02.DOC