PERMFILE57061

• Permit No: M2001001
• IBM Index Class Name: Permit File
• Doc Date: 3/9/2001
• Doc Name: INFORMAL CONFERENCE PREHEARING CONFERENCE AND FORMAL PUBLIC HEARING LINE CAMP PIT FN M-2001-001
• From: DMG
• To: NOTICE TO THE PARTIES AND INTERESTED PERSONS OF THE LINE CAMP PIT APPLICATI
• Media Type: D
• Archive: No

AUTHORIZATION TO REPRESENT A PARTY
(Please Type Or Print The Requested Information)
SIGNATURES M1IUST BE IN BLUE INK

(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
Borad in this matter. Representative's phone number ( ) - ,and address
(Street Address)
SIGNED AND DATED THIS
(City)
DAY OF
Authorized Signature (must be signed in blue ink)
STATE OF
(State) (ZIP)
If corporation attest (seal)
ss.
COUNTY OF )
The foregoing instrument was acknowledged before me this day of
by as of
NOTARY PUBLiC
My Commission expires:
SIGNATURES MUST BE IN BLUE INK
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