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~ ~ ~~~e ~ 5f <br />~ ~ I~~~lo1 ~1u rs, <br />AUTHORIZATION TO REPRESENT PA TY <br />(' PleaseTvp~/e~O/r Print The Requested Information) <br />1 ~' SIGNATURES MUST BE IN BLUE LYK 3O3 ~+~ `~~ <br />I ~r* ~ ~ ~Cb ~ ~ /~ <br />(Person's Name) (Tide) <br />of ~~ (,1name of company, association, organization, etc.) am <br />authorized to delegate ~N ~`~w ~C~'l5~ _, a ~AI~~G2 <br />/~.. , ~ ( son's Name) (Consultant, etc.) <br />to represent~~~•(~.C~` 1~ , - L . `~'7~ (name of person, company, association, <br />organization, etc.) at the Pre-heating Conference and/or Hearin, before the Mined Land Reclamation <br />Borad in this matter. Representative's phone number (°I ~U) 3/~ - 2'32 ~ ,and address <br />l alb ~ r+~ ~C , Gee l c v ~c~ ~o(0 3f <br />(Street Address) (City) (State) (ZIP) <br />SIGNED-AND DATED THIS ~~ DAY OF , ~~. <br />~~X .t 1 LJ''~ _ If corporation attes[ (seal) ~ECFI VE® <br />Authorized Signature (must be signed in blue ink) <br />MAY 2 2 2001 <br />Division of Minerals and Geology <br />STATE OF ~l n~C'a_rl o ) <br />ss. <br />COUNTY OF_~g~ ei`~ ) <br />The foregoing inswment was acknowledged before me this g~day of ~~o.x~. , ~o `~,~ <br />by as o- f~ <br />JERAE S. <br />VIGIL <br />S~ <br />NOTARY PUBLIC , <br />My Commission expires: ~ . 1 ~ .nom <br />SIGNATURES MUST BE IN BLUE [NK <br />M:bssbmmV.urlenzaunn io Repment a Partv.Gpe <br />