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<br /> <br /> <br />EXECUTION BY THE STATE OF COLORADO: <br />DIVISION OF MINERLS AND GEOLOGY <br />MINED LAND RECLAMATION BOARD <br /> <br />In witness whereof, this Agreement is dated and effective as of , 20 . <br /> <br /> <br />BY: DATE: ______________________ <br /> Division Director <br /> <br /> <br />STATE OF: ) <br /> ) <br />COUNTY OF: ) <br /> <br />The foregoing instrument was acknowledged, subscribed and sworn to before me this day of <br /> , 20 . <br /> <br />Witness my hand and official seal. __________________________________________ <br /> (Notary Public) <br />My Commission Expires: ____________________ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />02-07-97 <br />sb indem agree fd