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Page 5 of 5 <br /> Division records indicate the following permittee contact information. If this information is not current,please type or print <br /> current contact information: <br /> Permittee Contact: Helen Whinnery <br /> Permittee Company: Helen Whinnery <br /> Address: 2557 State Hwy 149 <br /> Powderhorn,CO 81243 <br /> Phone Number: (970)641-1678 <br /> Fax Number: (970)944-2517 <br /> Email Address: <br /> I,the undersigned,hereby state that the information provided in this report is true and accurate,and that site operations are <br /> being conducted in accordance with the Division approved mining and reclamation plans. <br /> ;j!v::C 'A' (Jm� Z4- l-P/�.t�l <br /> Signature of Permittee,Corporate Offiter,Owner,or Documented Designee ate <br /> M-AF-01 <br /> RECEIVED <br /> MAR 14 Z017 <br /> DIVISION 0 LA TION, <br /> MINING a RE �M ERALS <br /> In REPORT P <br /> �s 5 <br />