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<br /> <br />~ECF~V~~UTHORIZ~TIO~ TO REPRESS\T .-~ P.-ARTY <br />of (name of company, association. organization, etc.) am <br />authorized to delegare L d k" t ~~ {" , a ~~Qr Ul ~~ <br />_J_[ (Person's Name)( (Consultant, et .) <br />to represent Ci, I VlT (r Cf t ame of person, company, association, <br />organization, etc.) at [he Pre-heazing Conference and/or Hearing before the Mined Land Reclamation <br />Borad in this matter. Representative's phone number (303) ~~6 - / y~ ~ ,and address <br />/~/~~ ~~~, Sf , ,/pYlyel~ , ~o ,8aa4z <br />(Street Address) (City) (State). (ZIP) <br />SIGNED AND DATED THIS ~~A-~' DAY OF ~~ O l` <br />r <br />If corporation attest (seal) <br />Authorized Sign ture I(must~ be signed in blue ink) . <br />Title: ~Q Y' ~--C~,~ <br />STATE OF / D ~ ) <br />1~11~/iG j ss. <br />COUNTY OF <br />The f r poi e~nstrument s c no'w-le~~ed before me~ts t~day aF ~ , ~~ <br />by ~s T'(,t2L~r of <br />- (J ~ <br />~ ~ !l~ <br />NOTARY PUBLIC y ~j <br />~[y Commission expires: '1 -/l/ 'vS~/ <br />~(GST BE hi BLUE [Nh <br />?I `mv`pmml.lwhanxnnon m Reprtsm ~ Party Coc <br />MAY 21 ~^Ji <br />(Please Tvpe Or Print The Requested Information) <br />Division of Minerals and Geology <br />SIGSATL'RES 11CST BE L\~ BLCE [\'6 <br />