2007-10-18_REPORT - M2002053

• Permit No: M2002053
• IBM Index Class Name: Report
• Doc Date: 10/18/2007
• Doc Name: Annual Fee/Report/Map
• From: John R. Kurtzer
• To: DRMS
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

APtlYUAL FEE a' nd REPORT REQUEST
PERMTITEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
~ John R. Kurtzer
~M-2002-053
Kurtzer Pit
November 27, 2007
RE~~~V D
~~ 181001
piyisiAn of Rgoiatnratlon,
~ Mining end Safety
$$323.00 (Due on or before your anniversary date)
Phillips
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
_ _,---she}1=submii°`the =annual .fee, -a-report-and -map-showier-the-ext~..t-nf -cuncrtt-disturbances-tff affected -land,--- - -
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach vour revised written annual resort and annual report map to this form. The Annual Report
& Fee requirement is not met until we have received the following components: fee, report, and associated
map. If no new disturbances or reclamation have occurred durinc the previous veer and no new chances to
the previous year's map are necessary, then no new map is required, urovided that the Operator shall state
this in the Annual Resort. Please note that an adequately labeled map that clearly delineates and includes the
above elements may since for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: John R. Kurtzer
Permittee Name: John R. Kurtzer _
Address: 24463 CR 11
Haxtun, CO 80731 _
Phone Number: [phone] _
Fax Number: [phone] _
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Were Remo~c!
?OOG.~o~Do7
If you have additional comments and/or information that should
below or attach it to this form along with your written report and map. Annual Report instructions are enclosed.
~,~ ~~~
Signature of Corporate Officer, Owner, or Designee
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Date