2017-09-21_GENERAL DOCUMENTS - M2003073

• Permit No: M2003073
• IBM Index Class Name: General Documents
• Doc Date: 9/21/2017
• Doc Name: Agreement to Conduct Permitting by Electronic Means
• From: Moffat Limestone Company
• To: DRMS
• Email Name: GRM
• Email Name: SLB
• Media Type: D
• Archive: No

5. Affiant will inform the Division of Reclamation Mining and Safety within thirty
(30) days in the event that his/her authorization to execute ePermitting Documents
on the Company's behalf is terminated.
Further, Affiant sayeth not.
al r"'I I -
Affiant's name
Signature
Notarized Affidavit of Signature
STATE OF: )
COUNTY OF: )
The foregoing instru menf As acknowledged ,
before me this 1`f''" day of , 'Zil by
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of
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of permittee repres
JESSICA BARRETT,
Notary Public
State of Colorado
Notary ID N 20054014807
MV 4 Ian Va Ir =24.2
(seal)
My Commission expires:
(date) onth) (year)
as
� (title)
(permittee}
OTARY PUBLIC