Laserfiche WebLink
STATE OF COLORADO . <br />MI D LAND RECLAMATION BOARD <br />PARTY STATUS REQUEST FORM F~EGE1v~D <br />1 1999 <br />_ I request that 1 be named as a party Mp`( 2 <br />ov1S`o^ of M~oeta~ & ~eoW9Y <br />I request that I not be named as a party <br />I request to be withdrawn from party status <br />In the matter of File No. M-~~- D ~: <br />For people who do not wish to become parties in this matter, information on the permit <br />application process can be requested from the Division of Minerals and Geology. <br />Printed Nam <br />Pte. G,x ..~'Z.c <br />Address <br />L. AJS Co i~u SLlD <br />Cit ,State Zip Code <br />Home Phone # <br />Work Phone # <br />( 1 <br />FAX # <br />,/ E/M'ail Address <br />Signature ~o`~~' Date <br />If you are requesting to be named as a party, please briefly describe below how you may be <br />affected or aggrieved by agency action in the matter referenced above. Include a statement of <br />your opposition or support in the matter. You may attach a written statement to tltls form instead <br />of filling in the space below. Include a specific description of the issues that you feel need to be <br />addressed at the final hearing before the Mined Land Reclamation Boazd. <br />