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