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., ~ iiiiiiiiiiiiiiuiii ~o <br />STATE OF COLORAD~ <br />` MINED LAND RECLAMATION BOARD <br />PARTY STATUS REQUEST FORM <br />I request that I be named as a party <br />I request that I not be named as a party gECEIVED <br />I request to be withdrawn from party status <br />MAY 18 1999 <br />In the matter of File No. M- `~- 00 s: <br />~,: ~~~ of Minerals ~ Geology <br />~~~- ~il-e Pa~~.,~, <br />For people who do not wish to become parties in this matter, information on the permit <br />application process can be requested from the Division of Minerals and Geology. <br />i\~fhy Cyr av,~otir <br />Printed N e <br />30~I`I? ~wv Ir17 <br />Address <br />'~a. Jhn~a C O ~ t0~ U <br />CityCity, Stata Zip Code <br />E-Mail Address <br />~ v ~ n,CA~`~a~*~ <br />Signature <br />f~i°I 13t~4 -~~ 9 ~ `1 _ <br />Home Phone # <br />Work Phone # <br />FAX # <br />Da- tee` <br />If you are requesting to be named as a party, please briefly describe below how you may be <br />affected or aggrieved by agency action in the matter referenced above. Include a statement of <br />your opposition or support in the matter. You may attach a written statement to this form instead <br />of tilling in the space below. Include a specific description of the issues that you feel need to be <br />addressed at the final heazing before the Mined Land Reclamation 13oazd. <br />