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PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Permittee Contact: Glynda Yoder <br />Phone Number: <br />Fax Number: <br />Date <br />Boulder, CO 80304 <br />(303) 544 -1188 <br />(303) 442 -3822 <br />Signature Corporate Offic , Owner, or Designee <br />1-- z 2-- z-D // <br />M: \PERMITIMASTERDOCUMENT S/M- AF -02. DOC <br />ANNUAL FEE and REPORT REQUEST <br />Precious Offerings Mineral Exchange, Inc. <br />M- 1999 -074 <br />Brown Derby Mine <br />October 20, 2011 <br />$259.00 (Due on or before your anniversary date) <br />Gunnison <br />RECEIVED <br />/ OCT 11 2011 <br />Division of Reclamation, <br />Mining & Safety <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-shall-submit-the-annual-fee; a report -and- map - showing the - extent -of- current=disturbanccs 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 Name: Precious Offerings Mineral Exchange, Inc. <br />Address: 200 Alder Ln <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 />enclos <br />