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... _ s .. <br />'~ -flECEIVED STATE OF COLO:ZADO <br />. BAR ~ 9 ~~ MINED LA~iD RECLAMATION BOARD <br />p;,~tt at tutittera-r BtGt~9Y PARTY STATUS FORLv1 <br />In the matter of File No. M-oZ~O-~ <br />Name of Operator/Applicant and Site: <br />I request char I be named as a patty <br />~~ <br />I request that I not be named as a party <br />I understand that I have party status <br />I request I be withdrawn fror>f t parry status <br />I wish to address the Board at~the fottna! <br />hearing, if held, as a non-par <br />(Please note that if all objecting parties withdraw np ~or Co the date set for the Division's reco' mendation for <br />approval or dettial, there may not be an opportunity Yor any person to address the Board on ny issues related <br />to the application. If all objecting parties withdraw their objection after the above referent date, the Board <br />may still hold a formal hearing, however the Board is not obligated to cotssider any issues cd by a party that <br />has withdrawn.) <br />- Regardless of a party status, the Division thoughtfully considers each issue submitted in writing to the Division and <br />provides a response to those issues in the Division's "Rationale For Recomrnendadon ". The "12a ' Hale" is available to <br />_ _- any person by contacting the Division. For persons who do not wish to become a patty or withdra as a party in this <br />matter, please contact the Division for information an application status. <br />(Please provide)I dte following informazioa if you have or wish to have pasty status, thank you.) <br />~Q /` +-v F~ ~ (1C (~ <br />Printed Namt -~ ~ / Home Phone a <br />11~~~~SGJCl2 /4~ ( 03) C~- I l <br />Address Work Phanc ft <br />t~l4~ev; /lei ~~ S~O~s/ c3o3) ~ o <br />l3`]$ <br />City, Stare <br />7Zp Code FAX q <br />/I <br />/9'1Dr~l-ct.~a~ec~ ~ }CGCf~iter4v• CON1. QrLN Q~ <br />E-Mail Ad u e Date <br />~- ~~ <br />Signature <br />If you are not now a patty and you wish to be named as a patty, please provide the following: <br />• How you may 6e affected or aggrieved by the Boazd's decision if the Boad decides to approv the application. <br /> <br />(Please srrach additional pages if needed) <br />• Please explain your opposition to the matter, including s specific description of the issues that ou feel need ro be <br />addressed a[ the Formal Board Hearing and why. <br />(Please attach additional pages if needed) <br />100'39tid 3-10.10-t73NIHWOS-f15~ WObd £I ~SI i0. 6 ?JkiW <br />