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Y 1 <br /> 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 Si ng ature <br /> STATE OF: ) <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged <br /> before me this day of by <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of <br /> (permittee) <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires: <br /> Page 5 of 6 <br />