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9 (FORM 2 - Public filing) <br /> VIII. SIGNATURE REQUIREMENT <br /> Please place you initials on the line pros ided: <br /> ei7J(.. I hereby \erify that the foregoing information is true and accurate and commit to the reclamation of the <br /> aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br /> Hard Rock Metal Mining Rules and Regulations and this NOI form. <br /> -i'. I have enclosed the required permit fee. <br /> I authorize the Di\ision to contact and copy the BEM and or CSFS on any correspondence related to the prospecting <br /> operation.if the prospecting operation is located on federal public land. <br /> _14 ,— I has e also enclosed the appropriate reclamation surety amount or w ill post an amount as determined by the office. <br /> based on the projected costs of reclamation. <br /> 416.4'- I understand that I am not authorized to create any surface disturbance until the surety amount is posted and appros ed <br /> in writing from the Division of Reclamation.Mining and Safety. <br /> zeif I accept and agree to comply with the foregoing teens and conditions and with all of the pros isions of Rules 3 and 5. <br /> and C.R.S. 34-32-101. <br /> I herby certify that concurrent with submittal of this NOI to the Dis ision. I has e sent notice to the Boards of County <br /> �/� <br /> Commissioners in the Counties where the proposed actis ities will occur. This notice also indicated that non- <br /> confidential information regarding the proposed actin ities w ill be as ailable for res iew at the Din ision's w ebsite. <br /> This firm has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, GR.S., of the Mined Land <br /> Reclamation Act. Any alteration or modification qf this form shall result in voiding any.x'01 issued on the altered or modified <br /> form and subject the operator to cease and desist orders and civil penalties for operating without a.1'01 pursuant to section 34- <br /> 32-123, C.R.S. <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 /> gin en in this NOI form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this 12q j day of /4 f.7 I , <br /> Signature of NOT holder or person authorized to sign: <br /> 5.2,9/71(.."..____. <br /> Name(typed or print) Rick Wilson <br /> Title Position: Manager Q <br />