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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANN?EE and REPORT REQUEST <br />-k1ndian Springs Mining <br />VM-1981-020 <br />Thorsen Mine <br />May 6, 2009 <br />7 CD <br />PR 16 2UU9 <br />Division or mecumation, <br />Mining and Safety <br />$$323.00 (Due on or before your anniversary date) <br />Fremont <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 operator <br />shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br />-reclamation-accomplished_to date and during the _preceding_year, new disturbances that are anticipated to occur <br />during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br />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 Report <br />& Fee requirement is not met until we have received the following components: fee, report, and associated <br />map. If no new disturbances or reclamation have occurred during the previous year and no new changes to <br />the previous year's map are necessary, then no new map is required, provided that the Operator shall state <br />this in the Annual Report. Please note that an adequately labeled map that clearly delineates and includes the <br />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: Carlina Henry <br />Permittee Name: Indian Springs Mining <br />Address: 3257 CR 67 <br />Penrose, CO 81240 <br />Phone Number: (719) 372-3907 <br />Fax Number: <br /> <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />Belo or attach it to this form along with your written rep rt and map. Annual Report instructions are enclosed. <br />al <br />Signature of Corporate Officer e , or D rgnee t , <br />416? -0 15) <br />Date