Laserfiche WebLink
i` <br />~®~, C®IVFIDENTIAL <br /> <br />Form 1 -All information for DRMS use and confidential filing <br />NOTICE OF INTF,NT TO CONDUCT PROSPECTING OPF,RATIONS <br />FOR HARD ROCK/METAI: MINES <br />CHF;CK ONE_ There is an NOT Number Already Assigned tv this Operation <br />NOI ~ p_ - (Please reference the fle number assigned to this operation) <br />New NOI <br />lVi.oditication to an Existing NOI <br />NpI#1 P- - (Provide for iViodibeations to an existing NOI) <br />GENERAL OPERATION INFORMATION <br />Type or print clearly, in the space provided, AI..L information described below. <br />I. GENERAL INFORlVTATION <br />1. DATE NOI RECEIVED BY'I'IiE DIVISION: _ _ _ (afbce use onlyl <br />2. PROJEC'[' NAiV3E: Golden Age Number Two Mining Company _ <br />3. PR(3SPECTOR: PERSON MLRB SHOULD CONTACT: <br />Name: ----.Aztn_ L~mberg~-_-_....,....... Name: -_ Ann Lemberg -------_......__..._....__-._...._ <br />".i <br />President '~:•~_' :' .~~ =' `" Presi ent <br />Tith,: 'T'itle : ..............__------.._._....._...._-------- -__........_._-_ <br />- ~ - -~ "'Golden A e Number Two Mining CoCom an Name: _ g <br />~;,,.:.:- :.v;,<: ~t~az~pan.yNaine:~_._....__T.-._...g --._._._...------ p Y Golden.--AGe_..Numhex:--._Tz~o_._Minin Co. <br />.. <br />Street: 5059 B Valmont Road Street: ---„__„__,_.--__ 5059 B Valmont Road <br />P.O. Box: <br />City: Boulder <br />State: _...__._ps~_1_~.~'ado _.__.._.._...-----.._ ..................._.._....._......_......__..... <br />''/:,ip t;ocle: 80301__.---_......-__-----...__........___..--...._.__.____._....._._..._--- <br />'1-'i:l.eplaane Ntun.ber: 303-448-0277 <br />I~ax Number.: _ .__..-_..._...30_3_-4.4.9-7805-._----.--...---........ <br />~~~~n~~ <br />~' ~~~ 1 ~ ?6°~~9 <br />c ~j,(;1a~10(1, <br />pivisioo of ~. u ga¢e~~l <br />~flinin9 an <br />P.O. I3ox: <br />Ci.ty:.._.._...---- Boulder.__-_..._..----_____.....__._...._-..._._.._..-----_.__.... <br />State: Colorado <br />Tip C".ode:...__._..._$.03.0~_..-.--.--._..-----._.....__..._.._....._...._..__.._._._..._... <br />'Telephone N'uniber: _-._.__.303=448-0277 . --_____-- <br />Fax Nu,nber: 303-449-7805 <br />4. APPI.IC:A"I`ION F:E~E: $f36. (Nc..)L5 retlurre a 58G f~;e Vv121CIt ?T}uSt aCCOftipany this nonce or it cannot be grocessetl by the <br />Division}, <br />S. I:OCA':CI.ON INF OI2R'~IA7'ION: <br />C'ounty:-......B.pulde r...._..._._......_...__... <br />PI?l:.Nf::IPAI, .M1112I:I)AN (ctte.ck ones _-..---.X,_6'"" (C'o`re~rac~lo) .-----...._...lt}~' (Ne~v ~'l.cxi%o) -_......---.._.__._ l.l,.Jtc) <br />SI°C"I'IO:~i (write ntzrn;er): S -.36- _-- <br />