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I • <br />u <br />AUTHORIZED AGENT or REPRESENTATIVE - If DIFfERENT THAN PROPERTY OWNER (please prmt) :~ <br />Name: rus~er arnrr_ <br />127 N. Circle Dr. <br />Mailing Address <br />Phone OFFICE: (7191 315-2213 HOME:(~i9~3is_~~~a <br />', FAX: e-mail fscott705@aol-com <br />^ WRITTEN AUTHORIZATION FROM ALL PROPERTY OWNERS FOR AUTHORIZED AGENT TO <br />ACT ON THEIR BEHALF MUST 8E ATTACHED <br />NOTE: All correspondence regarding this Application will be addressed to the Authorized Agent or <br />Representative UNLESS otherwise requested. <br />. SURVEYOR (please print).- . <br />Name: SAf~ ~ BELL <br />Mailing Address <br />Phone OFFICE: HOME: <br />FAX: a-mail <br />ENGINEER (please print) <br />Crown Point Services <br />Name: <br />Po Box 749 <br />Mailing Address <br />Canon C' <br />Phone OFFICE: 17ig~~~s_snns HOME: N/- <br />FAX: (7191 269-2345 e-mail ~a <br />PROJECT LOCATION <br />Legal Description of Property: <br />• Subdivision: N/A <br />lot Block Filing Tract <br />• Section 13 Township 15s • Range 70'^'• OR Attach a Metes and Bounds legal <br />description and survey depicting the property boundary. ' <br />• MiningClaim~s);_ Scott Blue II <br /> <br />