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- .;...- - -1.- -- - - ~ - -------- - ---- ._ - . .... ----..... _. _ _ ....... <br />/ ~1~~~1 ~ J~bZy-Ip~ ~U ('Ci r <br />AUTHORIZATION TO REPRESENT PAR/TY~ <br />{~ <br />(Pleas TyPe Or Print The Requested Information) <br />1 ~' SIGNATURES ivIUST BE IN BLUE INK 3O3• ~+~'~~ <br />-/ <br />I ~~~~ ~ : ~ C In N ~ <br />(Person's Name) (Title) <br />of ~(pname of company, association, orga/niz^ation, etc~.)~apm <br />authorized to delegate L.U ~ ~ I ~ ~ ~~ . a ~'-~"~~X `~~`~ <br />(Person's Name) (Consultant, etc.) <br />to represent (~~,~~. L . ~ (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 (~) 2q(~. CI ~ l ~-, and address <br />/ ~ ~1 l / ~~ Sfi~ s~ r+e 3~, ~ f1 tl~ / C.c~ 0202. . <br />(Street Address) (City) (State) (ZIP) <br />SIGNED AND DATED THIS T DAY OF ~ otd~ <br />If corporation attest (seal) <br />Authorized Signature (must,telsi r^edJin blue ink) RECEIVE <br />Tide: yV /'~ <br />MAY 2 2 2C"1 <br />(~ UiYI$i0n Of Minerals and Geology <br />STATEOF__ l ~~rs~~c~ ) <br />ss. <br />COUNTY OF ~ ~ ~~a ) <br />The foregoing instrument was acknowledged before me this ~Lday of 1'l~l a,ti , o7..0C~1 , <br />by C"7O~ o .~ as <br />r,~~..P~s~,c . <br />. ..' ~~~~ <br />JERAE S. NoT.4RY PUB[.tC <br />VIGIL `o <br />My Commission expires:~~ ' ~- S ' Oa-- <br />TURFS MUST BE IN BLUE INK <br />M.bssb~Uur~orizaiion ,o acpresenr s Partv.tloc <br />