PERMFILE71290

• Permit No: M1998058
• IBM Index Class Name: Permit File
• Doc Name: HOW A PARTY MAY DESIGNATE A REPRESENTATIVE TO A PRE HEARIG CONFREENCE OR MLRB HEARING
• Media Type: D
• Archive: No

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AUTHORIZATION TO REPRESENT A PARTY
(Please Tvpe Or Print The Requested Information)
SIGNATURES MUST BE IN BLUE INK
I
of
(person's name)
authorized to delegate
(title)
(name of company, association, organization, etc.) am
(person's name)
to represent (name of person, company, association, organization,
etc.) at the Pre-hearing Conference and/or Hearing before the Mined Land Reclamation Board in
this matter.
SIGNED AND DATED THIS
Authorized Signature (must be signed in blue ink)
Title:
State of
DAY OF
If corporation attest (seal)
} SS
County of )
The foregoing instrument was acknowledged before me this
by as
,a
(consultant, etc.)
day of
of
Notary Public
My commission expires:
SIGNATURES MUST BE IN BLUE INK
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