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I-r(A <br />0,:-2 orb& (9--2q <br />Application Checklist <br />12' Application Form: Complete the form located on page 5. <br />C' Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />IT Performance Warranty: Complete the form located on page 11. <br />O'Financial Warranty: Submit the appropriate Financial Warranties or conditional <br />replacement Financial Warranties using the forms posted on the Division's website <br />9 12 (available online at http: / /mininc.state co us/Mineral %2OForms htm). <br />y�3 <br />[0 Demonstration of Legal Right to Enter: Identify the owners of all surface and mineral <br />rights, obtain the documentation described above, and submit to the Division. <br />Structure Agreements: Obtain new Structure Agreements if Permittee had been required <br />�2 <br />to do so. <br />att;Ut'.0 r 'tgt 'h' RECEIV D <br />f,n4, -r RECEIVED <br />MAY ?013 <br />JUL 113 2011 <br />DIVISI OF RECLAMATION <br />INGAND SAFETY DIVISION OF RECLAMATION <br />MININGAND SAFETY <br />-4- <br />