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Jun•l6. 2003 11:50AM AQUATIC WETLAND <br />2~ J d U~ ~ Lr <br />AUTHORIZATION TO REPRESENT A PARTY <br />~ECEIVEp <br />(Please Tyae Or Print The Requested Infortnatiozt) JUN 16 2QQ~ <br />Division of Minerals & Geology <br />SIGNATURES MUST BE IN BLUE INI~ <br />(person's name) (tide) <br />o£ (name of company, association; organizati ~, etc.) am <br />authorized to delegate C ~( r 'a~ , a <br />(per50n'S arrre) -~OrrSU)farit; CtC.) <br />r,~ 1 ~; <br />to represent b ~ .(name of person, company, association, ozganization, <br />etc. j at ~__ Pr hearing Conference 2nd/or He2nwg be.`er° the Mined Land P.eclaznation Iloarti in <br />•~uj fAa1Ao~ <br />SIG,DtET~AND DA.'I~D THIS,,,~~Da. <br />Authorized Signature (must be sign din b(ue ink) <br />nn ~ <br />Title: , // <br />State of ) <br />ss <br />County of ) <br />If corporation attest (seal) <br />The foregoing insu: ^~ent wasy~ackynowledged bef.,ra,$:e this ~., day of ~~~•-?- , o~pO~3/J' • //~1~, <br />n._ I -r ~.9 ~ /J <br />t~• <br />SIGNATURES MUST BE TN BLUE INR <br />A;\6Ucdae\prtywv~,wp <br />