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05/29/01 WED 15:05 FAB 9~T85 2590 WCB PLATfEVILLE <br />AC,tTHORIZ;~7IOti TO REI'RESE\T .~ PARTY <br />(Please Type Or Print The Reyuested Information) <br />SIG~i.aTtRES ~ifi5T AE L~ BLUE I:1'Ii <br />(Person's Namt) <br />(Tint) <br />of ii~l~n ~c; r• ~3~ (name of company, association, oreanization, etc.) am <br />f~ooz <br />authorized to deleeate ~ n ~ ~h~"/"~R , a A~{ oRNs <br />(Person's Yamt) (Con ultant, ew,) <br />to represent <br />(name of person, company, association, <br />organization, etc.) at the Pre-hearing Conference and/or Hearing before the Mined Land Reclamation <br />Borad in this matter. Representative's phone number ~~Q•f) ~iAL. - ~~/~ ,and address <br />i'/~il /R~ ~c'-/'._ 5;~~ ~a, oo .~~e~yvay~ ,~_. r~'a2oL_;Z ~ s <br />(Street Address) (City) (5[atc) (Z!P) <br />SIGNED A~iD llATEb THIS ~ R'~ DAY OF ~"1 H ~/ 2. oo i <br />~'~> oifc. `~ G 4G ~./?.~.t If cotporarion anest (seap <br />Authorized Signa[ure (mu,tt 6t signed in Glue ink) <br />STATE OF <br />W ,~ f ) ss. <br />COWi TYOF J[,~ ) ~/y <br />The F~egoCi7e instrument [warms ~acknowltdged btfore me this ~,=~ay of ~ l!/t-'C ~~~ I , <br />by C.1J~~ ~ 1'~ F C,~ ~ ~,JflLt f" <br />BRENDA K.. <br />ODEHBAUGH? N[7TAR~Y PLfALIC <br />r'~~ <br />w~Oc "rfN.O~~ My Commission expirts:_.~~ _ l ~-2c~ <br />SIGNATURES MUST BE IN BLUE INIi <br />}I:bss`pmmNushaliiauon sn o_........ „__.. ~.. <br />