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RECEI~IED <br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />ANNUAL FEE and REPORT REQUEST <br />The Clare Corporation <br />M-1989-044 <br />Twin Crk Campground <br />April 10, 2002 <br />APR Z Z ZU02 <br />Division of Minerals and Geology <br />$251.00 (Due on or before your anniversary date) <br />Teller <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 operator <br />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 vour revised written annual report and annual report man to this form. Please note than 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 permit[ee contact information. Please verify and make any necessary <br />changes: <br />Permittee Contact: Hazold E. Clare, II <br />Permittee Name: The Claze Corporation <br />Address: P.O. Box I <br />Florissant, CO 80816 <br />Phone Number: (719) 748-3805 <br />Fax Number: (719) 748-5120 <br />-~ If you have additional comments and/or information that should be provided [o the Division, please provide it <br />below or attach it to [his form along with your written report and map. Annual Report instructions are enclosed. <br />~Q~.~ G~ <br />Signature of Cor/porate Officer or Owner <br />/~ <br />Date <br />M:IPERM171MASTERD000MENTSIM-AFA] <br />