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9 (FORM 2 - Public filing) <br />VIII. SIGNATURE REQUIREMENT <br />Pleases place you initials on the line provided: <br />v I hereby verify that the foregoing information 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 form. <br />I have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br />/ operation, if the prospecting operation is located on federal public land. <br />I// 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 of reclamation. <br />I understand that I am not authorized to create any surface disturbance until the Surety amount is posted and approved <br />` ! in writing from the Division of Reclamation, 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 5 <br />P � PY g g P > <br />% and C.R.S. 34 -32 -101. <br />I herby certify that concurrent with submittal of this NOT to the Division, I have sent notice to the Boards of County <br />Commissioners in the Counties where the proposed activities will occur. This notice also indicated that non - <br />confidential information regarding the proposed activities will be available for review at the Division's website. <br />Thu form has been approved by the Mined Land Reclamation Board pursuant to section 34 -32 -113, C R.S., of the Mined 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 N01 pursuant to section 34- <br />32 -123, CR.S. <br />1, the undersigned. being the NOT holder or the person authorized to sign on behalf of the 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 115- day of A/ U 0,9A Xtb <br />Signature of NOI holder or person authorized to sign: <br />O <br />Name (typed or print) <br />Title/Position: Olt/ T A <br />