PERMFILE52086

• Permit No: M2005071
• IBM Index Class Name: Permit File
• Doc Date: 2/15/2006
• Doc Name: Status Update and Citizen Participation Guide
• From: DMG
• To: Parties Commenting on Appl
• Media Type: D
• Archive: No

AUTHORIZATION TO REPRESENT A PARTY
(Please Tvae Or Print The Requested Information)
SIGNATURES MUST BE IN BLUE INK
I
(person's name)
of
authorized to delegate
(title)
(name of company, association, organization, etc.) am
.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 Board i^.
this matter.
SIGNED AND DATED T1HS DAY OF
If corporation attest (seal)'
Authorized Signature (must be signed in blue ink)
Title:
State of )
ss
County of )
The foregoing instrument was ac]mowledged before me this
by as
Notary Public
My commission expires:
SIGNATURES MUST BE IN BLUE INK
day of
of

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