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9 (FURM I - All injormaaion jor DRMS use an7 conjl-denlial f,l;„g) <br />V11I. RUN AI UKE KhOUIKEMEIN 1 <br />RECEIVED <br />AUG 19 2015 <br />GRAND FUNCTION FIELD OFFICE <br />uMSION Or <br />RECLAMATION MNING 3 SHFET <br />riezzae pince yuu niitials of, th'c liuc p.ovia'ca: <br />1 ne.eby ve.ity that the to.egai..g i..to....atio.i is bue and accurate aua commit to the reclamation of the <br />21fu.e. uc..tiuuea p.u3pectirlg aitc as 'N"CU Dy the Coin. M;.,CU KCC lau.at.vu Act at the . ulca as apeciTleed .n the <br />Hard Rock/MeLal Mining Rules and Regulations and this NOI form. <br />� I have enclosed the .equi.ea pe, mit tee. <br />I authorize the Division to contact and copy the BLM and or I'SFS o., any co—cspondc. zc rclecd to the N1e3F=ti.19 <br />Dpeiativu, it tnc pjUapCCtiug OpMativi. ;a 1OZatCU Off MUMal piWhC IauU. <br />I have alsu enClusea the app.upuate IrClailiatioii suety amount of will punt an au.ouut as determined by the Mice. <br />� Dared o., the p.ei:.et;,d %rata ef.e;,la...atie... <br />l u..aelatai3 that I U111 [lot authu.icca to crate ally su.race aiatu.bance u..til the aanety annnounnt is poate8 aua appnovea <br />i.. w,iti..g f o... the Uivisiv.. of Kecla... at;o.., IVli..i..g and .)afcry. <br />1 accept aua agree to comply with the ronegoing tennnns aua conditions annd with all of the provisions of Rules 3 and 5, <br />a.,a C. K. S. J4-31- I U I . <br />I nc.by certity that rancau'cut with aub...ittal or tnia NUI to the uiviaiou, I have sent notice to the Lza.d�, or County <br />Commissioners in the Counties where the proposed activities gill occ— I his notiei:; alae ...dicated that ..e..- <br />conntldennt;al intoe,nation regarding the proposed activities will be available for review at the Division's website. <br />This form has been approved by rite Mined Land Reclamarion Board pursrant to section 34-32-W, C.K.S., of the mi,.ed Lrr,.d <br />Reclamation Act. Any altera-rion or modificarion of this form shall result in voiding any NOI issued on the altered or modified <br />julm UrO mubj:ct the apul Uta: to Crum: trod hiatal U1 r/e13 a1111 civil p:,[nllirm far Uprruting withaut u Not purmuuirt to mcctiDn JW - <br />3L -/L3, C.K.3. <br />I, the undersigned, being the NOI holder or the person authorized to sign on behalf of the NOI holder, declare that the information <br />6v'cu ni this N0-1 tour .s t.ue a..a M iW. <br />SIGNA I UKLS MUS I UL IN ISLUr 1NK <br />Sig..ea a..a mated tnis 1 ' t aay or c \ I 2o l J <br />Signature M N01 halUer or person authoriiea to sign: <br />Name (typed v1 p. ;fit) 1 1 G \ n- <br />Title'Posidon: IUB ll z'(1 U�t 6r <br />