Laserfiche WebLink
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 />L, &607,1 <br />Affiant's name <br />Signature <br />Notarized Affidavit of Signature <br />STATE OF: � d D ) <br />COUNTY OF: xw� y) <br />The foregoing instrumerit Was acknowledged <br />before me this ILM <br />(date) <br />ss. <br />,&Iolr,�L� 1-eg) 0 <br />(Name of permittee representative) <br />JESSICA BARRETT <br />Notary Public <br />State of Colorado <br />Notary ID # 20054014807 <br />M omrnl la ,r , . �2t <br />(seal) <br />My Commission expires: <br />61,4 / /,�-/ <br />day of 2601-1 by <br />(month) (year) <br />as <br />IO <br />(title) (J <br />of <br />(permittee) <br />ARY PUBLIC <br />Page 5 of 6 <br />