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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 ePermiWag Documents <br /> on the Company's behalf is terminated.' <br /> Further;-Affiant sayethfriot: . <br /> Affiant's name , <br /> Signature <br /> Notarized Affidavit of Signature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> .The foregoing instrument was ac_lmowledged " <br /> before me this " day of b <br /> -� Y <br /> (date) (month) (year) <br /> as <br /> (Name of peimittee representative) <br /> of <br /> (permittee) <br /> NOTARY PUBLIC <br /> _(seat) <br /> MY Commission expires: <br /> Page 5,of 6 <br /> I <br />