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PERMITTEE NAME: Gold Eagle Mining, Inc. <br />PERMIT NO.: M- 1977 -297 <br />OPERATION NAME: Burros Mine <br />ANNIVERSARY DATE: November 29, 2011 <br />ANNUAL FEE DUE: $518.00 (Due on or before your anniversary date) <br />COUNTY: San Miguel <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 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 man 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 />de in tes and ' ludes the above elements may su ice fora ritten report. <br />j_ <br />u�,.� a�� � ,Ge ,t? <br />Division recoindicate the following permittee ng pe ttee contact • formation. Please verify and make any necessary <br />changes: <br />Permittee Contact: Don Coram <br />Permittee Name: <br />Address: <br />Date <br />M: P <br />Gold Eagle Mining, Inc. <br />P.O. Box 3007 <br />678S0 Ogden <br />Montrose, CO 81402 <br />Phone Number: (970) 596 -2425 <br />Fax Number: (970) 249 -0731 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach to this form along with your written report and map. Annual Report instructions are <br />enclosed. <br />Mt� Sign e o Corporate Officer, Owner, or Designee <br />/ V40/ / <br />Z e e /7417 1 f ,160(-- - JO -c- 7 4- "C ia-C j - <br />ANNUAL FEE and REPORT REQUEST <br />