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AL FEE• and ORT REQUEST <br />PERMITTEE NAME:f ` Id Eagle Mining, Inc. <br />PERMIT NO.: ? M-1978-342 <br />OPERATION NAME: Ellison Mine <br />ANNIVERSARY DATE: February 15, 2011 <br />ANNUAL FEE DUE: $518.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <br />RF-r,F1VF-0 <br />/AR 2 4 20ti <br />€ i?aia?or :-1; Wt+ abon, <br />seety <br />71 Mit,dng and <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 />_--m?rator 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"thai are dnficipateTto - - <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 vour 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 may 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 />delineate and includes the above elements may sufce for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Coram <br />Permittee Name: Gold Eagle Mining, Inc. <br />Address: P.O. Box 3007 <br />68750 Ogden Road <br />Montrose, CO 81402 <br />Phone Number: (970) 596-2425 <br />Fax Number: (970) 249-0731 <br />If you have additio 1 comments and/or information that should be provided to the Division, please provide it <br />below or atta (ito his form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />a - /,'_ z d/ /' <br />Date <br />M: \PERMITIMASTERDOCUMENTS/M-AF-02.DOC