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Day of , , made and entered into by and between the THIS AGREEMENT, dated this STATE OF COLORADO, acting by and through the STATE BOARD OF LAND COMMISSIONERS, hereinafter called the State, and hereinafter called the surface owner: WITNESSETH WHEREAS, the surface owner has applied for a mineral development restriction covering all minerals* underlying ; and the land described below and has paid a filing fee in the amount of $ WHEREAS, said application has been approved by the State and is hereby.

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