Laserfiche WebLink
<br />AUTHORIZATION TO REPRESENT A PARTY <br />(Please Tvae Or Print The Requested Information) <br />SIGNATURES iVIUST BE IN GLUE INK <br />(person's name) (title) <br />of (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-heazing 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 fore;oing instrument was acknowledged before me this <br />by as <br />of <br />Notary Public <br />My commission expires: <br />SIGNATURES d[UST BE IN BLUE INK <br />day of , <br />A:~blkdoc\prtywve.wp <br />