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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 /> 4 Qla.,ye-1 Zr6e IF,yet-_(Z' <br /> Affiant's name <br /> Signature X, , <br /> Notarized Affidavit of Signature <br /> STATE OF: � ) <br /> Ale w a-x/c a <br /> COUNTY OF: ) ss. <br /> The foregoing instrument was acknowledged � <br /> before me this 13 day of D�elj ] by <br /> ___jd6_ __ <br /> (date) (month) (year) <br /> as <br /> (Name of permittee representative) (title) <br /> of*'Bye-r-s� <br /> (permittee) <br /> NOTARY PUBLIC <br /> (seal) <br /> My Commission expires- n,� <br /> r►l ! 1 '0l� <br /> Page 5 of 6 <br />