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r ~ STATE OF COLORADO <br />~ MI1Qf~.D LAND RECLAMATION B~RD <br /> <br />``~" i <br />:: ~- <br />J A Mc w .A <br />PARTY STATUS REQUEST FORM ~~GE1vE0 <br />I request that I be named as a party MAC 21 ~g99 .: <br />I request that I not be named as a party ' a S,Un otM~t,e~ah &Geow9'1:. `' <br />;,; •. <br />I request to be withdrawn from party status <br />In the matter of File No. M-$1 - os-7 <br />~• , <br />r: . <br /> <br /> <br /> jd. <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 />' ~/P ~ 1 ~ /~ M e~.S t3v~) x'37_ o Uzi . <br />Printed Name Home Phone # <br />Address O Work Phone # <br />City, State iZip Code FAX # - <br />E-Mail Addre s . } ,~ <br />ignature Date .,;`' ' ~~ <br />r„j ?~. <br />IC 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;~Z ~~,1 .. <br />your opposition or support in the matter. You may attach a written statement to this form insteadi .' <br />of filling in the space below. Include a specific description of the issues that you feel need to be';~ <br />r.,.rr- <br />addressed at the final hearing before the Mined Land Reclamation Board. - - ~ ' ;t ;~`"`~ <br />,: _ . <br />. r,~ <br />-k . <br />,.v1j. 4. <br />~~ A, <br />__ _.. 1`.., `. <br />s_f . , ~F <br />y; <br />1~~ <br />