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2015-04-28_GENERAL DOCUMENTS - M2015022
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2015-04-28_GENERAL DOCUMENTS - M2015022
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Last modified
8/24/2016 5:59:39 PM
Creation date
6/18/2015 8:18:23 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M2015022
IBM Index Class Name
GENERAL DOCUMENTS
Doc Date
4/28/2015
Doc Name
Affidavit of Authority to Execute FW Documents
From
Lazy H Inc
To
DRMS
Email Name
PSH
WHE
Media Type
D
Archive
No
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pSt4 <br />r>n a 0t5 o 2-7- <br />Affidavit <br />2Affidavit of Authority to Execute Financial Warranty Documents <br />Before me this day, the undersigned 'A) i I I% CA rYl 1401 J C'r►q GN r [name of authorized <br />person], in his/her capacity as j' aLnei q P ,- /n w r) e r [title authorized person] ("Affiant' <br />personally appeared and, being first duly sw n upon oath said: <br />1. This affidavit is being executed and submitted on behalf of Lg fit4 14 -r le- [name <br />of business organization], a(n) (�t1('(J(;f -*,+iQ [legal form of business organization, <br />e.g., corporation, partnership, limited liability company, etc.], in good standing in the State of Colorado (the <br />"Company"). <br />2. It is in the interest of the Company to execute certain financial warranty documents associated with file <br />number M 2 015.0 2 Z (DBMS file number), which are required by the Colorado Mined Land <br />Reclamation Board and Division of Reclamation Mining and Safety pursuant to Colorado law ("Financial <br />Warranty Documents"). <br />3. Affiant is duly authorized to sign such Financial Warranty Documents on behalf of the Company and to <br />bind the Company to the same. <br />4. Affiant is not prohibited or limited by the Company's governing documents or by any applicable law from <br />executing the Financial Warranty Documents. <br />5. Affiant will inform the Division of Reclamation Mining and Safety within thirty (30) days in the event that <br />his/her authorization to execute Financial Warranty Documents on the Company's behalf is terminated. <br />Further, Affiant sayeth not. <br />tj I I lI Gc 'n /4ow e n cA 0%r- RECEIVED <br />Affiant's Name <br />0 Q� � APR 26 2015 <br />Signature IZZ [division of Reclamation, <br />Mining & satety <br />STATE OF <br />ss.: <br />COUNTY OF <br />The foregoing in1str anent was acknowledged before me this -day of d j <br />by l,.)�1�t0.m 'N�c,)t as U..�rac of Zv1 <br />Notary Public <br />My Commission Expires )6;I _ <br />Susan K Kitmian <br />Notary Public <br />State Of Colorado <br />Notary ID 20044041221 <br />MY COMMiW F11res f3ae,.nh. 24 2016 <br />
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