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 /> Affiant"s name <br /> Signature <br /> Notarized Affidavit of Signature <br /> STATE OF: <br /> COUNTY OF: ) ss. <br /> The foregoing instrument waLa&nowledged <br /> before me this day of �', f by <br /> (date) (month) (year) <br /> as / <br /> (Name of permittee repress tative) (title) <br /> of <br /> (permittee) <br /> ANN V. CAFFEY <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID <br /> MY COMMISSION # <br /> 3193 <br /> EXPIR;:R NOVEMBER 07,2018 z 9 ul/ �tl /7 <br /> C .L/ <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> l 7 C <br /> Page 5 of 6 <br />