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J <br />AUTHORIZATION TO REPRESENT A PARTY <br />(Please Tvpe Or Print The Requested Information) <br />SIGNATURES MUST BE LN BLUE INIC <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-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 acknowledged before me this <br />by as <br />of <br />Notary Public <br />My commission expires: <br />SIGNATURES iv1UST BE IN BLUE IN6 <br />day of <br />.~.\6lkdoc\pnywve. wp <br />