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~~ i 6 ~5 0~ <br />,/ ANNUAL FEE and REPORT REQUEST <br />PERMITTEE NAME: ~ Joseph Curtis Harden RE~~! ` ~~ <br />PERMIT NO.: M-2004-008 ~ a <br />~ ~ z 3z©os <br />OPERATION NAME: The Mountain Mining Claim Dlvlslon of Recla <br />matio <br />ANNNERSARY DATE: October 28, 2006 inm9 and Satety n, <br />ANNUAL FEE DUE: $225.00 (Due on or before your anniversary date) <br />COUNTY: Clear Creek <br />According to_C~.S~3.4~2.5_I_Ifi_oLC.R.S_34~2116,_each year, 9n_the_anniversary date_of the pemtit,.an__ _ _ _ <br />operator shall submit the annual fee, a report and map showing the extent of current disturbances to affected <br />land, reclamation ~,cco„ m~,ished to date and during the nrec ;ne yga_ new di_tyrhan~r~ that are anticipated to <br />occur during the uncomini; year, reclamation that will be performed during the coming year, the dates for the <br />beginning 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 map to this form. The Annual <br />Report & Fee requirement is not met until we have received the following components: fee, report, and <br />associated map. If no new disturbances or reclamation have occurred durinc the previous vear and no <br />new chances to the previous year's map are necessary. then no new man is required. provided that the <br />Operator shall state this in the Annual Report. Please note that an adequately labeled map that clearly <br />delineates and includes the above elements may since for a written report. <br />Division records indicate the following permittee contact information. Please verify and make any necessary <br />changes: / <br />Permittee Contact: Joseph C. Harden / <br />Permittee Name: Joseph Curtis Harde/n <br />Address: P.O. Box 1207 <br />Idaho Springs, CO 80452 <br />Phone Number: (303) 567-2259 <br />Fax Number: N/~ <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~withQyour written report and map. Annual Report instructions are <br />S afar of Corporate Officer, O'ry/wner, or Designee <br />1D - Le -z6 0 6' <br />Date <br />MiPERM/TIMASTERDOCUMENTSMI-AF-02.DOC <br />