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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 />�, ) t, k 8, A— C <br />Affiant's name <br />091111ture <br />Notarized Affidavit ol`Signature <br />STATE OF: �Al Wj L] 122) <br />COUNTY OF. ) <br />�� rfrm <br />The foregoing instrument was acknowledged <br />before me this )9 day of <br />(date) <br />SS. <br />LL 8 as <br />(Name of permittee representative) (title) <br />Fw'ALEA FOSTER <br />Notary Public <br />Carbon County <br />Wyoming <br />ETH <br />mmission Expires Jun 18, 2018 <br />(seal) <br />My Commission expires: <br />of <br />, 01'7 by <br />(month) (year) <br />Z I d . ... ► >t� S <br />` PUBLIC <br />Page 5 of 6 <br />