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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <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 />-- — operator submit fee, - a iepor'C arrd 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: Roger Tichenor <br />Permittee Name: Wildcat Mining Corporation <br />Address: 1630 Ringling Blvd <br />Sarasota, FL 34236 <br />Phone Number: (941) 951 -0787 <br />Fax Number: (941) 951 -0864 <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 />e closed. <br />Signature of Corporate Of r, Owner, or Designee <br />Date <br />9J <br />M:\PERMIT MASTERDOCUMENTS/M- AF- 02.DOC <br />%R F <br />ANNUAL FEE and REPORT REQUEST <br />VWildcat Mining Corporation <br />/ 1981 -185 <br />May Day Mine <br />September 5, 2011 <br />$259.00 (Due on or before your anniversary date) <br />La Plata <br />RECEIVID <br />✓ AUG 1 1 2011 <br />Division of Reclamation, <br />Mining and Safety <br />