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O5{29/01, WED. 15:08 FA3 970 785 2590 WCB PLATTEVILI.E <br />AUTHORIZATION TO REPRESENT A PARTY <br />l~}009 <br />(Please Tvne Or Print The Requested Information) <br />SIGNaTURES MUST BE IN BLUE I~iK <br />I >M I~~~L K . 7 ~•G ~Y~GZ-- -.^ ~7Wnl ~i2-- ~or3 ccToZ <br />(Persani Name) (Ti[Ic) <br />of l t1~1. (.~ ~ C. tZ 3~ (name of company, association, organization, etc.) am <br />t~LPr?TE(~IGC..F ~t7(oS/ <br />authorized to delegate ^ LD IZI l~0!/~'1- , a _,_• ~4TI-0 >~/~~c. t'~1t~~?~~~j _1 <br />(Person's Nanta) (Consultant. [c~j <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 />$orad in this matter. Representative's phone number I~7`D31 ~-9 6- _/ ~ /~- ,and address <br />~~~ll t 8 f S ( Su,r~~ 3e.~ , ~l~rcv~- . ~_,~J~SS~ <br />(Street Address) (City) (State) (ZIY) <br />SIGNED . D D~TE THIS ~~/~` ~ DAY OF ~ rLL' . ~CY -` I • <br />t <br />~~ ~ if corporation a[tcsc (seal) <br />Authoriz Si,natvre (mart be signed in b! in.E) <br />T~ <br />STATE OF ~~ -~ <br />.~ ~ 1 ) ss. <br />!~ ~ ~ <br />The F`oregoin~S"i~stnt~ment~was acknowledged before me [hiss%day of ~~~G~'r,' <br />by i `1•' -t((~,~.Sryt...-_J_\ ~t^..[~~las ~Cl.~,~/~ _ __aP_ _- <br />Rr r~ <br />~~tP,........, 9~~c <br />r ' '4t <br />j BRENDA K.' NOTARY PUBLIC ~ <br />DDENBAllGH?o <br />N': l <br />J`~;, ,~~~ My Commission expires: ~-~-ZC~ <br />SIGNATURES MUST BE IN BLUE INK <br />