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W <br />9 (FORM 2 - Public filing) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />1 hereby verify that the foregoing mbrmation is true and accurate and commit to the reclamation of the <br />aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br />Hard Rock/Metal Mining Rules and Regulations and this NOI Corm. <br />_ I have enclosed the required permit fee. <br />I authori-a the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br />operation, ifthe prospecting operation is located on federal public land. <br />I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, <br />based on the projected costs ofreclamation. <br />I understand that I am not authorized to create any surface disturbance until the sm-ety amount is posted and approved <br />in writing from the Division ofReclamation, Mining and Safety. <br />I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and S, <br />IR S. 34 -32 -101 . <br />certify that concurrent with submittal ofthis NOI to the Division, I have sent notice to the Boards ofCounty <br />Csioners in the Counties where the proposed activities will occur. This notice also indicated that non- <br />confidential inbrmation regarding the proposed activities will be available for review at the Division's website. <br />This form has been approved by the limned Land Reclamation Board pursuant to section 34 -32 -113, C.R.S., of the Nfined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any NOI issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NOI pursuant to section 34- <br />32 -123, C.R.S <br />t the undersigned, being the NOI holder or the person authorized to sign on behalfofthe NOI holder, declare that the information <br />given in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this day of WI &A kto <br />Signature ofNOt ho r o pe n arrtho ' d to sign: <br />Name (typed or print) <br />Title/Position: <br />