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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) 832 -8106 <br />May 8, 2012 <br />Mined Land Reclamation <br />TO: Accounting Dept, DRMS <br />FROM: Christine Brookshire, Minerals, DRMS <br />SUBJECT: Request Refund Check. <br />I am requesting a refund check to be cut for: Black Range Minerals for $86.00. The <br />operator submitted a modification and now wishes to withdrawal. The fee is $86.00. I am <br />requesting a refund for Permit No. P- 2009 -025 <br />Contact Info: <br />Black Range Minerals <br />110 N. Rubey Drive, Suite 201 <br />P.O. Box 18041 <br />Golden, Co 80402 <br />Ben Vallerine <br />(303) 279 -4946 <br />Respectfully, <br />Christine Brookshire <br />Admin. Asst. <br />Enclosure: Receipt, for $86.00 <br />cc: Tom Kaldenbach, DRMS <br />Timothy Cazier, DRMS <br />STATE OF COLORADO <br />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />— &— <br />SAFETY <br />John W. Hickenlooper <br />Governor <br />Mike King <br />Executive Director <br />Loretta E. Pineda <br />Director <br />Office of Office of <br />Denver • Grand Junction • Durango Active and Inactive Mines <br />