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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 Si nature <br /> STATE OF: Cl <br /> � /o <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this 7 day of ^-e- 112 e,1 -7 by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) / <br /> of �� f 0 ,- Ile <br /> (permittee) <br /> ROBBIN SHACKELTON <br /> NOTARY PUBLICSTATE OF COLORADO <br /> NOTARY 10 0 201114 522210 NOTARY PUBLIC <br /> MY COMMISSION EXPIRES AUGUST 18,2019 <br /> (seal) <br /> My Commission expires: <br />