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l <br /> <br /> <br />~,~YlICFCOF1Uyi ~ `~7 ~ ~ S .v <br />reclamation only if the Board ties determined: <br />i. that reclamation required by law to <br />have peen performed upon such lands has not been performed. <br />and <br />ii. that financial warranty forfeiture <br />proceedings described in the act or similar provisions of <br />subsequent laws if any• have Seen initiatetl. <br />5. The additional StlpUldt10n5 set forth in the <br />attached rider, if any• are incorporated herein by reference. <br />/____/ a) Rider is attached. <br />/~/ b) No rider is attached. <br />ACCEPTED AND AGREED: MINED LANC RECLAMATION BOARD <br />MINED LAND RECLAMATION D14ISION <br />COLORADO CEPARTMENT OF <br />NATURAL RESOURCES <br />~7,~,~~~. sl~(,~- <br />Division Director <br />BY ~~~~~~~~~~~~~~~~~~~~ , ~~ <br />,,~' ~ r ,Y <br />'`7_ ~' ~~~~ . c <br />Notarization of Operators Acknowledgment - >'~•. JI <br />STATE l_!BK~C'c-d-{~~l _____~_) _ ... <br />~f ~-- ) S 5 . <br />COUNiY OF Q~.Caf'(Y ______) <br />Tne foregoin instrument was acknowledged before me <br />tnis ~__ day of _~_L~t_~~____, 19g_ by ___ as _ of _• the operator. <br />NOTaRY PUBLIC <br />-4- <br />