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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 /> Affiant's name <br /> Signature <br /> Notarized Affidavit of Signature <br /> STATE OF: /� ) <br /> C_-C �c r t �✓ z <br /> COUNTY OF: / ` ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this ? - day of / b <br /> y <br /> (date) (month) (year) <br /> (Name of permittee representative) (title) <br /> of �/� <br /> r 1 ' / Lc i F ✓e /fc cfCcc 7 L <br /> (permittee) l <br /> ROBBIN SHACKELTON <br /> NOTARY PUBLIC <br /> 1 STATE OF COLORADO <br /> NOTARY ID#20114052210 <br /> MY COMMISSION EXPIRES AUGUST 18,2019 NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 5 of 6 <br />