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STATE OF COLORADO <br />DIVISION Of RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherma" St„ Room 315 <br />Denver, Colorado 80203 <br />Phone: (303) 86&3567 <br />FAX: (303) 832 8166 <br />CY? <br />I7l4riw(:3 tll,f? f s, , Ji;i1. <br />y&t :i 4?s se.fj g?{ <br />COLORADO <br />DIVISION O•F <br />RECLAMATION <br />MINING <br />SAFETY <br />Bill Owens <br />Governor <br />&SjS19N-MENT OF CERTIFICATE OF DEPOSIT Russell George <br />Executive Director <br />Ronald W. Cattany <br />TO WHOM IT MAY CONCERN: Division Director <br />Natural Resource Trustee <br />REFERENCE: Certificate of DePosit Numb <br />By submission of this letter, to be attached to the above referenced Certificate of Deposit, I hereby relinquish all title and <br />claim to said certificate to the State of Colorado/Mined Land Reclamation Board, except for accrued interest against the <br />original monies, until such tirm as the Division of Reclamation, l Ming and Safety/Mined Land Reclamation Board releases <br />the certificate. This assignment of Certificate of Deposit supersedes any signature cards that may already be on file at the <br />bank. <br />ACKNOWLEDGMENT OF BANK <br />i <br />SIGNATU <br />By. Jc'--?v 5 o04L-t <br />TITLE: Yr? v LIGL v? 6th <br />DATE: Ir i /zo6 <br />Note to Operator: <br />BY: <br />Operator: <br />Depositor of Original Monies <br /> <br />NOTARY Qf Ooefator'gignature) <br />Cod s n Expires 7 ??4 <br />C"V67,tdo <br />?4 • S i=R? <br />r' . c <br />NOTARY i < <br />PUBLIC <br />NY Comn6sion Expires 04119/2009 <br /> <br />This assignment will need to be executed in the presence of a notary. The original is held by the Division with a <br />copy provided to the bank, to allow only Division of Reclamation, Mining and Safety access to these funds <br />Office of Office of <br />Mined Land Reclamation Active and inactive Mines