Laserfiche WebLink
STATE OF COLORADO <br />MI E;D LAND RECLAMATION B ARD <br />~: <br />PARTY STATUS REQUEST FORM <br />;'. <br />` i ~, <br />I request that I be named as a party ~ <br />I request that I not be named as a party c~ECE1V.ED I , <br />MAY 21 1999 i <br />I request to be withdrawn from party status Geolo9Y <br />r;rvison of Minerals & <br />in the matter of File No. M-~~-DS7 ~, <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 />I,tlr~1L N/e~a„~,~hRUs <br />Printed Name <br />~t o /v s` U r~e. l~ ~~ C.~ o us <br />Address <br />~.Vn,uJ CU `13DSZ10 <br />City, State Zip Code <br />f ~ - <br />Home Phone # <br />Work Phone # <br />FAX # <br />E-Mail Address <br />~ ~ <br />~~ <br />o~~~ <br />Signature <br />~'t~l 99 <br />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 this 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 Board. <br />