REV89270

• Permit No: M1989024
• IBM Index Class Name: Revision
• Doc Name: TRANSFER OF APPROVED MINERAL APPLICATION AND SUCCESSION PERMIT APPLICANT
• Type & Sequence: SO1
• Media Type: D
• Archive: No

•
_Z.

Applicant and Successor hereby request the State to consent to the assignment of the approved Permit
Application to recognize the Successor as the approved Applicant u~d~r the permitting process.
Name of Permit Applicant
(~e
By
Signature of OfTicer
By
Signature of Officer
t.G~
Titl of Officer
( S/Fh(l/~
Title of Officer
NOTARY FOR PERMIT APPLICANT
STATE OF
ss.
COUNTY OF ~(;ZF~IrO )
The fore a' s was aclotowledged before me this ~ day of DEC~~~- ~ ~~g
by '••• , l I~ as ~=~M IT i'~ PSI Cfb~
•
of a": ~ ~' • R!
ci~~••iOV ~C;•' q° NOTARY PUBLI
°F °°~° 1a41~~~
My Commission expires:
My Commission E~ires 09124I20~TARY FOR SUCCESSOR APPLICANT
STATE OF ~~[7L~~'I~~ )
ss.
COUNTY OF ~(,(F~L~ )
The foregoing inASntrumce,(ntnwas aclmo`w~ ledged before me this _ (o day of .nm ~vP` ~~- ~ ~~
by ~U1~f ~~f I r 1 , d r'' ~ L~ CCJ- as b'~(r~ / ~f~r r-c-rG~-
of
NOTARY PUBLIC
My Commission expires: ~ I~}-M' ~ °~~ Z