Laserfiche WebLink
<br />AUTHORIZATION TO REPRESENT .~ PARTY RECEIVED <br />(Please Tvpe Or Print The Requested Information) MAY 2 3 2001 <br />SIGNATURES MUST BE [.Y BLUE INK Division of Minerals and Geology <br />I ~{~GC e~/Vi ~~ <br />7- (Parson's Name) (Tide) <br />of (nam`e/of company, association~oyr~sga~nization, etc.) am <br />au[horized to delegate ~ + ~Y , a <T fw«'~ <br />~~ ~ (Person's Name) (Consultant, etc.) <br />to represent ~/Y~ y"/IUIG~ (name of person, company, association, <br />organization, etc.) a[ the Pre-hearin; Conference and/or Hearing before the Mined Land Reclama[ion <br />~3 d 9~0' 9 ~~' <br />Borad in this matter. Representative's phone number ( ~- ,and address <br />~ ~D <br />(Street Address~~~/ /~Sj `U 1~ (City)~y~/~~ (Stale), (ZIP) <br />' ,~~~/ <br />SIGNED AND DATED T S DAY OF , ~~. <br />Signed in bk~e ink) <br />If corporation attest (seal) <br />STATE OF /iQ~l//(%~ ) <br />ss. <br />COUNTY OF ~,IICiJ~ ) , I') <br />The foregoing instrument was acknowledged before me this~day of <br />by <br />as <br />SIGNATURES ivIUST BE IN BLUE INK <br />•~i <br />'-'~' <br />. ~~ <br />V r - ", <br />ARY PUBLIC T <br />~~,"~ -- - <br />My Commission expires: ~~r``e`~ -~ ° ` <br />~rnFsn:ee new, <br />.+1:`oss~pnvnV\w Mrixauon ~o Represent x Pany.COc <br />