Laserfiche WebLink
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 /> 1? iLl L, . C7j .,' <br /> Affiant's name <br /> Signature <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> 'I .h0 <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this ' day of v t , D-01/49 by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> (permittee) <br /> ANN C, ROBISON <br /> Notary Public , s <br /> State of ldahc <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> I CD/ /DO/ e <br /> Page 5 of 6 <br />