Laserfiche WebLink
Jun.16. 2003 11:50AM <br />AQUATIC WETLAND <br /> <br />.No.3603i P. 2 <br />X0''7' 03v ~~ D(P <br />AUTHORIZATION TO REPRESENT A PARTX ~""'~ <br />(Please Type Or Pant The Requested Information) RECEIVEQ <br />SIGi`IATUAES MU5'1' BE AV BLUE It+IK ~~M 1 6 2~~~ <br />I '~ ~~ ~ ( ~ 6 nIIaELI..~ ~~e~-~-~_ Division of Minerals & Geology <br />(pezson's name) (tide) <br />of <br />authozized to delegate <br />to represent C c+.~i z <br />etc.) at the Pr eating Corfere*.ce <br />this matter. <br />of company, association, organization, etc.) am <br />a ' 1`J- <br />(consultan ,etc.) ~ ~f <br />of perso~i, com any,~ssociation, organizatioza, <br />ig beforet~e Mined Laad Reclamation $oard in <br />SIGIVETJ A\~ D~.TF.~ Tk115_ I Z DAB' OT~~__ _.> ~_.~_.. <br />~.._., V <br />~. If corporation attest (seal) <br />th ed n e (must3e signed to blue ink) <br />Title~~(Z <br /> <br />ss <br />county of ~~ e ) <br />The(f~or~eg~oi(n~g ins~trumennt camas acknowledged~b~ efore me t/hjis ,_,(~ day of _~~~- , oZ00 3 _ <br />by `'-" ~"`~ ~Ua,vldtpXY 2s..rl,PAt.Pit~tiC ~ of <br />My <br />SIGNATURES MUST BE IN BLUE INK <br />~~ <br />A:\bllcdx\pnyw~e,wp <br />