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M ow:5( <br /> Agreement to Conduct Permitting by Electronic Means <br /> 5. Affiant will inform the Division of Reclamation Mining and Safety within thirty <br /> (30) days in the event that his/her authorization to execute ePermitting Documents <br /> on the Company's behalf is terminated. <br /> Further, Affiant sayeth not. <br /> Affiant's name <br /> S' nature <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: � ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this '�? day of , '�jC)kL by <br /> (date) (month) (year) <br /> as , <br /> (Name of p mittee repre ntative) (title) <br /> of <br /> G n <br /> (permittee) <br /> Nicole Thomas <br /> Notary Public <br /> State of Colorado <br /> Notary ID 20124031891 <br /> My Commission Expires July 19,2016 OTARY <br /> (seal) <br /> My Commission expires: ,r _ <br /> ►�D <br /> Page 5 of 6 <br />