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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE <br />ANNUAL FEE DUE: <br />COUNTY: <br />r <br />ANN AL FEE and REPORT REOUEST <br />r <br />Mount Royale Ventures, LLC <br />VM-1994-117 <br />Gold Hill Mill <br />July 26, 2009 <br /> <br />RECF-WED <br />JUL ?? 2009 <br />pNision oI ?eclamauon, <br />iff Mining and tee/ <br />$$259.00 (Due on or before your anniversary date) <br />Boulder <br />According-to-C-.R-S-34-3-25--146-or-CRS-34-3-2-1-1-6; each-year; en4he anniversary- date-of-the-per-mit-,-an <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation accomplished to date and during the preceding 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 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: <br />2 . ? <br />Permittee Name: Mount Royale Ventures, LLC <br />Address: P.O. Box 19754 <br />Boulder, CO 80308 <br />Phone Number: a j _ Q <br />Fax Number: - _ <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporat Officer, Owner, or Designee <br />Date <br />M:IPERMITIMAS TERDOCUMENTS/M-AF-02. DOC