2009-05-04_REPORT - M1991054

• Permit No: M1991054
• IBM Index Class Name: REPORT
• Doc Date: 5/4/2009
• Doc Name: Annual Fee/Report/Map
• From: Indian Creek Mining Corp.
• To: DRMS
• Permit Index Doc Type: Annual Fee/Report
• Media Type: D
• Archive: No

PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE
ANNUAL FEE DUE:
COUNTY:
ANNUAL FEE and REPORT REOUEST
Indian Creek Mining Corp
M-1991-054 L,-'
Profitt
May 29, 2009
$86.00 (Due on or before your anniversary date)
Saguache
MAY 0 4 2009
e?matior+,
D'tv+dion of ?
.
and Safety
Mln+n9 ?, _ -?
MAY 0 4 2009

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
>Qp?rator_shall: submit the annual fee, a report and m? showing the extent of current disturbances to affected
land, reclamation accomplished to date and during the preceding year, new distur ances t at are anticipa e? fo
occur during the upcoming year, reclamation that will be performed during the coming year, the dates for the
beginning of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual report and annual report map to this form. The Annual
Report & Fee requirement is not met until we have received the following components: fee, report, and
associated map If no new disturbances or reclamation have occurred during the previous year and no
new changes to the previous year's map are necessary, then no new may is required, provided that the
Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly
delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: Don Flickinger
Permittee Name: Indian Creek Mining Corp
Address: P.O. Box 350
Kodiak, AK 99615
Phone Number: [phone]
Fax Number:
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annual Report instructions are
enclosed.
Signature of Corporate fficer, Owner, or Designee
Y-?- y --o 17
Date
M:\PERNHT\MASTERDOCUMENTS/M-AF-02.DOC