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L 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 � day of b <br /> (date) (month) (year) <br /> Signature of NOI holder or person authorized to sign .e�t`•�e►t/' <br /> Name (typed or printed): w, �M CsMi <br /> Title/Position: <br /> M:\min\oss\slb\MineraisForms\ProspectForm1 <br /> 30 Aug 2017 <br /> Form I—DRMS Use and Confidential File Page 14 0f 14 <br />