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I the undersigned, being the NOI holder or the person authorized to sign on behalf of the NOI <br />holder, declare that the information given in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this 19 day of 2 Q I,IJ <br />(date) (mo th) (year) <br />Signature of NOI holder or person authorized to sign: o ��---- <br />E <br />Name (typed or printed): <br />Title/Position: �! U <br />M:\min\oss\slb\MineralsForms\ProspectForm1 <br />30 Aug 2017 <br />oI,✓htP--- <br />Form 1— DRMS Use and Confidential File Page 14 of 14 <br />