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<br />PERMITTEE NAME: <br />PERMIT NO.: <br />OPERATION NAME: <br />ANNIVERSARY DATE: <br />ANNUAL FEE DUE: <br />COUNTY: <br />Tiger Timber,Ine. <br />M-1991-082 <br />Tiger Timber Site <br />March 17, 2003 <br />fiECEiVED <br />M~~ i 41003 <br />Division of Minerals and Geology <br />$281.00 (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 />PI ae ce__,___~ttach ~nnr revised written anneal report and annual red nrt martn 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: Frank Laughrey <br />Permittee Name: Tiger Timber, Inc. <br />Address: P.O. Box 128 <br />- - Phone Number: <br />Fax Number: <br />Lake George, CO 80827 <br />(719) 748-3621 <br />If you have additional comments and/or information that should be provided to the Division, please provide it <br />below or attach it to this form along with your written report and map. Annual Report instructions are enclosed. <br />~~~~ ~~ ~~ <br />Signature of Corporate Offie ,.Owner, or esignee <br />Date <br />M:iPERMITN1ASiERD000MENTSiM-AF-01 <br />