Laserfiche WebLink
Limited Power Of Attorney <br />I 5 4 -psi/ residing at <br />zi-e of <br />(' Agent") to sign required Colorado Division of ' eclamation, <br />Limited Impact Operation (110(1)) Reclamation Permit. <br />, hereby appoint <br />as my Attorney -hi -Fact <br />g and Safety related forms for the <br />This Power of Attorney shall become effective immediately and shalt not be affected by my disability or <br />lack of mental competence, except as may be provided otherwise by an applicable state statute. This is a <br />Limited Power of Attorney. This Limited Power of Attorney shall continue until December 31, 2015. This <br />Limited Power of Attorney may be revoked by me at any time by providing written notice to my Agent. <br />Dated 7// , 2015: at fitr h1/a) L , 1 CD , <br />YOUR SIGNATURE: <br />YOUR PRINTED FULL LEGAL NAME: <br />S /c'v, 111 );r>4 <br />WITNESS' SIGNATURE: <br />WITNESS' PRINTED LEGAL NAME: <br />WITNESS' SIGNATURE: <br />WITNESS' PRINTED FULL LEGAL NAME: <br />)....L., -c.)( Ir <br />STATE OF CO O, <br />COUNTY OF ! 'V SS <br />Subs ''bed and s i • to before me <br />this <br />d of <br />f /!e► er <br />Notary Public <br />My Commission Expires <br />O0l N. Washington, Thornton, CO 802'29 <br />KAfTLXN M. HEIN <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY 10 20144029928 <br />MY COMMISSION EXPIRES 07/301201S <br />