2012-04-19_REPORT - M1977004 ‎(2)‎

• Permit No: M1977004
• IBM Index Class Name: REPORT
• Doc Date: 4/19/2012
• Doc Name: ANNUAL FEE/REPORT
• From: HOMESTAKE MINING COMPANY
• To: DRMS
• Email Name: RCO
• Media Type: D
• Archive: No

APPROVED:
State of Colorado
Mined Land Reclamation Board
Division of Minerals and Geology
CA tbria
REVISED 01109
- 6 -
NOTARIZATION OF OPERATOR'S ACKNOWLEDGEMENT
STATE OF _ )
)ss.
COUNTY OF )
The foregoing instrument was acla owleddcd before ale this day of
by as of
NOTARY PUBLIC
,
My Commission expires:
By: Date:
Division Director