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(FORM 2 - Public ft!!ng) <br />VIII. SIGNATURE REOUIREMENI <br />Pleasc place you initials on the line provided: <br />1 hereby verify that the foregoing information is true and accurate and commit to the reclamation of the <br />aforementioned prospewng site as required by the Colorado Mined Reclamation Act and the rules as spcciEied 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 USES on any comspondcncc 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 1 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. 3432.141. <br />I herby certify that concurrent with submittal of this NOl to the Division, I have sent notice to the Hoards of County <br />Commissioners in the Counties when 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 website. <br />This finale has been approved by the Mined Lard Reckmaden Beard pursuant to secdan 34-32-113, CR.S, Of the Mixed Land <br />Redaau den Act Any alteration or ma& leaiar ofthis form shall resale In voiding any N01 kwed an the altered or mo&jled <br />fame and subject Ake operator to cease and desist orders and civil penaldes for operaliag without a N01 pursuant to section 34- <br />32-123, C.RS <br />I. the undersiowd. being the NOl holder or the persos-juthq&Wjq signjjbehalf of the NOI holder, declare that the infgMation <br />given is true and correct, <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this 97 day of l=kle t i r , 2- C) <br />Signature of NO[ holder or person authorized to sign: <br />r <br />r <br />Name (typed or print) ` �' 1-'F 2 �, C <br />Title Position: _ [� c .��, —r — 'J <br />