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DIVISION OF RECLAMATION, MINING AND SAFETY <br />Depamnent of Natural Resources <br />1313 Sherman Si, Room 215 <br />Denver, Colorado 80203 <br />Phone: (303) 866-3567 <br />FAX: (303) 832-8106 <br />1. option A: P)3 - <br />(Initial & Date) <br />2. ODtion 13: <br />(Initial & Date) <br />Office of <br />Mined Land Reclamation Denver • Grand )unction • Durango <br />m IL ei -o�� S ° <br />STATE OF COLORADO <br />• <br />n11(; '15 2012 <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: 1) an Application Fort; 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 />COLORADO <br />D I V I S I O N O F <br />RECLAMATION <br />MINING <br />SAFETY <br />I wish to WAIVE MY RIGHT to a 30-day processing time to allow the <br />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 wanranty requirements.* <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 FINANCIAL WARRANTY COULD BE <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 />Lvov - Aln/Le <br />/1-Agt(to 0/5boia <br />Office of <br />Active and Inactive Mines <br />