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�tq I'A-4 <br />M 1414- 14( <br />Application Checklist <br />Application Form: Complete the form located on page 5. <br />[Application Fee: Include check payable to Colorado Division of Reclamation, Mining <br />and Safety. <br />C9" Performance Warranty: Complete the form located on page 11. <br />❑ Financial Warranty: Submit the appropriate Financial Warranties or conditional <br />replacement Financial Warranties using the forms posted on the Division's website <br />(available online at http:/ /mining. state .co.us /Mineral %20Fortns.htm). <br />121 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 />to do so. N 4 .71 ( 010 <br />fGG , 5�; y <br />0 `M I <br />r���� ?— �D � ►3 — L�Gl.�G <br />-4- <br />