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4 (FORM 2 -Public filing) <br /> VIII. SIGNATURE REQUIREMENT <br /> Please place you initials on the line provided: <br /> 4 I hereby verify 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 have enclosed the required permit fee. <br /> _ I authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br /> operation,if the prospecting operation is located on federal public land. <br /> I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, <br /> based on the projected costs of reclamation. <br /> I understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved <br /> in writing from the Division of Reclamation,Mining and Safety. <br /> I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br /> and C.R.S.34-32-101. <br /> l� I herby certify that concurrent with submittal of this NOI to the Division,I have sent notice to the Boards of County <br /> Commissioners in the Counties where the proposed activities will occur. This notice also indicated that non- <br /> confidential information regarding the proposed activities will be available for review at the Division's webs ite. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, C.R.S.,of the Mined Laud <br /> Reclamation Act Any alteration or modification of this form shall result in voiding airy N01 issued on the altered or modified <br /> form and subject the operator to cease and desist orders and civil penal ies for operating without a N01 pursuant to section 34- <br /> 31-123,C.R.S. <br /> 1 the n i n in the NOI holder r the r th rized to sign on behalf of the NOI holder declare that the information <br /> given in this NOI form is true and correct. <br /> SIGNATURES MUST BE IN BLUE INK <br /> Signed and dated this day of <br /> Sig to of NOI hol4Vor pers uthorized to sign: <br /> me(typed or print} _ _R <br /> Title/Position: re J9 7, <br />