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• III IIIIIIIIIIIII III •`K# " S 9 �' <br /> 999 <br /> ANNUAL FEE and REPORT RE UEST REC <br /> o Ely�C <br /> PERMITTEE NAME: LKA International Inc. OCT 0 4 2000 <br /> PERMIT NO.: M-1978-091-UG division of glinerals and Geology <br /> OPERATION NAME: Golden Wonder Mine <br /> ANNIVERSARY DATE: October 1,2000 <br /> ANNUAL FEE DUE: $450.00(Due on or before your anniversary date) <br /> COUNTY: Hinsdale <br /> According to C.R.S. 34-32.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an <br /> operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected land, <br /> reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur <br /> during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning <br /> of active operations,and the date active operations ceased for the year,if any. <br /> Please attach your revised written annual report and annual report may to this form. Please note that an <br /> adequately labeled map that clearly delineates and includes the above elements may suffice for a written report. <br /> Division records indicate the following permittee contact information. Please verify and make any necessary <br /> changes: <br /> Permittee Contact: Kye A. Abraham <br /> Pemuttee Name: LKA International Inc. <br /> Address: 3724 47th St. Ct. NW 0. L3d X ga <br /> Clay' ('10 ?1a.35 <br /> Gig Harbor, WA 98335 <br /> Phone Number: (206) 851-7486 /U^ / 7/ f ��5 <br /> Fax Number: 9`'- q— 0/9 g <br /> If you hav additional comments and/or information that should be provided to the Division, please provide it <br /> below or ch it to this form along with your written report and map. Annual Report instructions are enclosed. <br /> i ture of Corporate Officer or Owner <br /> CJ <br /> Date <br />