Laserfiche WebLink
AUTHORIZATION TO F.EPRESENT A PARTY <br />(Please Type Or Print The Requested Information) <br />SIGI~TATUI2ES MUST BE IDI BLUE INK <br />I <br />(person's name) (title) <br />of (name of company, association, organization, etc.) am <br />authorized to delegate <br />(person's name) <br />,a <br />{consultant, etc.) <br />to represent (name of Berson, company, association, organization, <br />etc.) at the Pre-hearing Conference andlor Hearing before the Mined Land Reclamation B oaid 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 aclmowledged before the this day of , <br />by as of <br />Notary Public <br />My commission expires: _ <br />SIGi~IATURES MUST BE IN BLUE INK <br />A:Vilkdec~7rY~'~T~"'P <br />