Laserfiche WebLink
<br />A[;THORIZATIO\ TO REPRESENT A PARTY <br />(Please Tvpe Or Print The Requested Information) <br />SIGNATURES MUST BE IN BLUE IN6 <br />I <br />(person's name) <br />of <br />authorized to delegate <br />a <br />(person's name) (consultant, etc.) <br />to represent (name of person, company, association, or;anization, <br />etc.) at the Pre-hearing Conference andlor Hearing before the LVlined Land Reclamation Boazd in <br />this matter. <br />SIGNED AND DATED THIS DAY OF , <br />If corporation attest (seal) <br />Authorized Signature (must 6e signed in blue irtk) <br />Title: <br />State of <br />ss <br />County of ) <br />The foregoing instrument was acknowledged before me this day of , <br />by as of <br />Notary Public <br />My commission expires: _ <br />S[GNATURES iVIUST BE L\ BLUE INK <br />(title) <br />(name of company, association, organization, etc.) am <br />A:VblkdocVpnyv.ve wp <br />