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532( i <br />Sods <br />DIVISION OF RECLAMATION, MINING AND SAFETY <br />Department of Natural Resources <br />1313 Sherman St, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 8324106 <br />MAR082O12 <br />Division of Reciar>jatign, <br />Mining & Safety <br />TRANSFER OF PERMIT AND SUCCESSION OF OPERATORS <br />APPLICATION FORM <br />The application for a Transfer of Permit and Succession of Operators must contain four (4) major parts: I) an Application Form; 2) <br />an Application Fee; 3) a Performance Warranty (attached as part of the Application Package) bearing the original notarized <br />signature of the Successor Operator; and, 4) a replacement Financial Warranty provided by the Successor Operator, bearing an <br />original notarized signature. To expedite processing, please provide the information in the format and order described below. <br />FINANCIAL WARRANTY INFORMATION (Choose ONE Option): <br />1. Option A: N /A* 1 wish to WAIVE MY RIGHT to a 30-day processing time to allow the <br />(Initial & Date) Division of Reclamation, Mining and Safety to recalculate the Financial <br />Warranty requirements. If you choose Option A you should not submit a <br />Financial Warranty and Performance Warranty until the Division notifies you <br />of the correct amount of your warranty requirements.* <br />2 Option B: N/A* <br />(Initial & Date) <br />M 200( - 0 /o <br />STATE OF COLORADO <br />RECEIVED <br />I DO NOT WISH TO WAIVE MY RIGHT to a 30-day processing time. I <br />hereby submit a replacement Financial Warranty for the same dollar amount <br />as the Financial Warranty maintained by the current operator. I understand <br />that the Division of Reclamation, Mining and Safety will recalculate the <br />required reclamation bond within 60 -days from the date that the transfer is <br />completed and the required <br />SUBSTANTIALLY INCREASED at that time. As the new operator, i agree <br />to be responsible for posting any required increase to the financial warranty <br />for good cause shown, in a form acceptable to the Board, within 60 -days of <br />such notice. <br />* Las Animas County is a governmental entity. <br />Office of <br />Mined Land Reclamation Denver • Grand ;unction • Durango <br />COLORADO <br />D r V t a l O e o r <br />RE CLAMATION <br />MINING <br />SAFETY <br />Office of <br />Active and Inactive rte <br />O u- sr— �►' s ►K <br />tai /— d/ <br />— eY / d/ / 20 /2 <br />