PERMFILE46548

• Permit No: M1999025
• IBM Index Class Name: Permit File
• Doc Date: 3/8/1999
• Doc Name: MEMO PARTY STATUS IN MATTERS BEFORE THE MLRB
• From: MLRB
• To: FILE
• Media Type: D
• Archive: No

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AUTHORIZATION TO REPRESENT A PARTY
Please Tine Or Print The Renuested Information
SIGNATURES MUST BE IN BLUE INK
I
(person's name) (ti[le)
of (name of company, association, organization, etc.) am
authorized to delegate , a
(person's name) (consultant, etc.)
to represent (name of person, company, association, organization,
etc.) at the Pre-hearing Conference and/or Hearing before the Mined Land Reclamation Soard in
this matter.
SIGNED AND DATED THIS DAY OF
If corporation attest (seal)
Authorized Signature (must be signed in blue ink)
Tide: ____
State of
) 6S
County of )
The foregoing instrument was acknowledged before me this day of ,
by as oP
Notary Public
My commission expires: _
SIGNATURES IYtUST BE IN BLUE INK
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