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STATE OF COLORADO ~ } ~~ ,~ ~' ' ~' <br />MI I'sD LAND RECLAMATION BOARD '~'~~ ~~ ~' <br />.~ . <br />~, <br />. .: ` - , . <br />PARTY STATUS REQUEST FORM <br />~~ , <br />I request that 1 be named as a party ~FCEIVED <br />/ I request that I not be named as a party MAY 21 1999 <br />_~~ I request to be withdrawn from party status ,.~ _i Mineray &Geoto9Y <br />I: <br />In the matter of File No. M-~'7 - os 7 ', <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 />~ ~~ ~- <br />J ~-rr f „~1 v FN r ~ <br />Printed Name <br />Address <br />~.~/iJ~s GcS 'five '-Gl <br />City, State Zip Code <br />Home Phone # <br />f ) - <br />Work Phone # <br />f 1 - <br />FAX # <br />.f/2 ~I 99 <br />Date <br />~/ <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 <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 />1.~ <br />I' <br />