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9 (FORM 2 - Public ftling) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />t 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 N01 form. <br />I have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BhM and/or USFS on any correspondence related to the prospecting <br />operation, if the prospecting operation is located on federal public land. <br />Y 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 />1 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 />Y 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 />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 website. <br />This forint has been approved by the Mined Laud Reclamation Board pursuant to section 34-32-113, CR.S, of the Mined Land <br />Reclamation Act. Any alteration or modification of this fortrt shall result in voiding any NOl issued on the altered or modified <br />form and subject lite operator to cease and desist orders and civil penalties for operating without a N01 pursuant to section 34- <br />32-123, C.R.S. <br />1. the undersigned. being the NOI holder or the person authorized to sign on behalf of the NQ[ holder. declare that the information <br />given in this NO] form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this 5 day of 4IIS T_ 20 1( <br />Signature of NOI hoer or person authorized to sign: <br />6 lLllzd;l(l ')7r id fo- 14ht c 13,�►1(�a ' �1Ihi nl lkaw,f>Ij (4 ��21�// <br />Name (typed or print) y� I✓h T' }},, j ,f <br />Title Position: aJ LJk[ /h�ru,/,rti &1W <br />