2015-02-27_GENERAL DOCUMENTS - M2014070

• Permit No: M2014070
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 2/27/2015
• Doc Name: Damage Waiver For Exhibit S
• From: GoodMiller #2 Pit
• To: DRMS
• Section_Exhibit Name: Exhibit S
• Email Name: ECS
• Media Type: D
• Archive: No

1
NOTARY FOR STRUCTURE OWNER WITHIN 200 FT OF REVENUE MINE AFFECTED
AREA
ACKNOWLEGED BY:
Structure Owner Name
Date Title
STATE OF )
) ss.
COUNTY OF )
The foregoing was acknowledged before me this day of
as of .
My Commission Expires:
Notary Public
20_, by
t