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NOI NAME: Jack Clark, Jr. <br />NOI NO.: P- 2010 -003 <br />OPERATION NAME: Greyhound Mine Exploration <br />ANNIVERSARY DATE: January 18, 2012 <br />ANNUAL FEE DUE: $86.00 (Due on or before your anniversary date) <br />COUNTY: Ouray <br />On the anniversary date of the Notice of Intent (NOI), the operator must submit the annual fee. <br />Division records indicate the following NOI contact information. Please verify and make any necessary changes: <br />Explorer Contact: Jack Clark <br />Explorer Name: Jack Clark, Jr. <br />Address: P.O. Box 767 <br />Phone Number: <br />Fax Number: <br />ANNUAL FEE AND REQUEST FOR UPDATE OF INFORMATION <br />Silverton, CO 81433 <br />(970) 387 -5243 <br />(000) 000-0000 <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. We thank you for your attention to this matter. <br />Date <br />Signature . orporate Officer, Owner .r Designee <br />2 - l4 -2 0// <br />M \OSS\MR1\ANNFEE\LETTER1 11- 14- 2011\LE111:R111- 1- 11 -P\P- 2010 -003 F1 DOC <br />®k <br />©X <br />