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.AgARP7 <br />ANNUAL FEE mad REPORT REQUEST <br />PERNIMME NAME: Precious Oz"jM Nii ral Exchange, Inc. / <br />PERMIT NO.: M-1999-074 <br />OPERATION NAME: Brown Derby Mine <br />ANNIVERSARY DATE: October 20, 2009 D ??J <br />ANNUAL FEE DUE: X59.00 (Due on or before your anniversary date) <br />COUNTY: Gunnison <br />According to C.R.S. 3432.5-116 or C.R.S. 3432-116, each year, on the anniversary date of the permit, an <br />operator-shall submkthe *+ual.?, a m iandmap wing_ihe a f?cuneenLdisl?banees toected __ - __ _ <br />land, reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to <br />- - occur g lna?,1 Ge coming Me year, <br />beginning of active operations, and the date active operations ceased for the year, if any. <br />Please attach your revised written ansuai report and a ntual resort may to this forma. The Annual <br />Report & Fee requirement is not wd until we have received the Mowing emposents: he., reyoM and <br />associated into. If no new diatiubanoes or reclmntion have occurred darinz the previous year and no <br />new changes to the previous year's- may are necessary. then me new stay is require& provided that the <br />Operator shad state this in the Annual Report Please note that an adequately labeled mqp that clearly <br />delineates and and des the above elements may srroke for a written report. <br />Division records indicate the following permitter contact infiormation. Please verify and make any necessary <br />changes: <br />Permittee Coact: Glynda Yoder <br />Permittee Name. Precious Offerings blineral Exchange, Inc. <br />Address: 200 Alder In <br />Boulder, CO 80304 <br />Phone Number. (303) 5441188 <br />Fax Number. (303) 442-3822 <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 we <br />enclosed. <br />Signature of Corporate Officer, Owner, or Designee <br />Date <br />M AF-02DOC