Bond Release Application and Public Notice Advertisement

OMB Control No. 1029-0043

Expires: 11/30/2018

EXAMPLE

Bond Release Application

A separate application form is required for each permit increment. Please type or print clearly.

Application for phase bond release

Permit No. Increment No.

Permittee

Contact Person Telephone No.

Address

Acres Permitted

Acres Disturbed

Bond Type: Indicate the type of bond and the notification address for the issuing institution(s):

Surety Company Surety Bond No.

Agent/Underwriter Name Telephone No. Address

Certificate of Deposit No. Letter of Credit No. Other

Bank Name Telephone No.

Address

Permittee Reclamation Certification:

I certify that all applicable reclamation activities for phase bond release have been accomplished in accordance with the requirements of the Surface Mining Control and Reclamation Act, the Tennessee Federal Program, and the approved reclamation plan.

Permittee/ Authorized Representative Signature

Title Date

Subscribed and signed before me by (print name)

This day of ,

Notary Public My Commission Expires

Paperwork Reduction Act Notice

Permittees file this form (or similar form) with the regulatory authority for the release of all or part of a performance bond in accordance with 30 CFR 800.40. You must provide the requested information to obtain a benefit (release of the bond).

The time needed to complete this form and submit the requested information will vary depending on individual circumstances. We estimate that the average time will be 12 hours per response. This estimate includes preparation of the application, obtaining a notarized certification of compliance with reclamation requirements, preparation of the public notice for advertisement in the local newspaper, and preparation and mailing of letters to adjoining property owners, local governmental bodies, planning agencies, sewage and water treatment authorities, and water companies. If you have comments concerning the accuracy of this estimate or suggestions for simplifying the form or instructions, you may write to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, 1849 C. Street, NW, Room 4559, Washington, D.C. 20240.

Under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), you are not required to respond to, nor will you be subject to a penalty for a failure to comply with, a collection of information unless it displays a currently valid OMB control number.

OMB Control No. 1029-0043

Expires: 11/30/2018

EXAMPLE

Public Notice Advertisement

Bond Release Application

(Permittee Name and Address)

is applying for Phase bond release on Permit No. , Increment No. (if applicable) , which was issued on (date) . The (permit/ increment) consists of acres, and is locates in County,

(Provide precise location) . The bond amount for this permit or increment is $ in the form of (Specify bond type: Cash, Certificate of Deposit, Surety, etc.) . A bond release of $ is requested.

The bond release is based on completion of the following reclamation:

1. Types of reclamation performed.

2. Appropriate date(s) of reclamation work performed.

3. Description of reclamation results achieved as they relate to the approved reclamation plan.

4. Description of the post-mining land use.

Written comments, objections, and requests for a public hearing or an informal conference may be submitted to the Office of Surface Mining Reclamation and Enforcement, 710 Locust Street, 2^nd Floor, Knoxville, TN 37902, prior to (Date) , which is 30 days following the last publication.

Do not include this in Public Notice Advertisement

Paperwork Reduction Act Notice

Permittees file this form (or similar form) with the regulatory authority for the release of all or part of a performance bond in accordance with 30 CFR 800.40. You must provide the requested information to obtain a benefit (release of the bond).

The time needed to complete this form and submit the requested information will vary depending on individual circumstances. We estimate that the average time will be 12 hours per response. This estimate includes preparation of the application, obtaining a notarized certification of compliance with reclamation requirements, preparation of the public notice for advertisement in the local newspaper, and preparation and mailing of letters to adjoining property owners, local governmental bodies, planning agencies, sewage and water treatment authorities, and water companies. If you have comments concerning the accuracy of this estimate or suggestions for simplifying the form or instructions, you may write to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, 1849 C. Street, NW, Room 4559, Washington, D.C. 20240.

Under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), you are not required to respond to, nor will you be subject to a penalty for a failure to comply with, a collection of information unless it displays a currently valid OMB control number.