Laserfiche WebLink
AUTHORIZATION TO REPRESENT A PARTY <br />Received <br />(Please Tvne Or Print The Requested Information) MAY 1 ~ 2~~~ <br />SIGNATURES hIUST BE IP 1 HLUE LYK <br />Durango Field Office <br />Ohrision of Minerals 8 Geologx <br />I ~~/~n/Tole ~•9i~~~at/ <br />(Person's Name) (fide) <br />p~c'irrza/S f:~~~oc~.vf'~4~i~iTy~`~fda/SiB~ci <br />of ~F~,~ ((name of company, association, organizati n/et`c~) a/m~ ,--a <br />authorized to delegate ~>~~~ CCJIIC',~,~T , a ~~~~ v1' C~/'~`~ <br />(Person's Name) (Consultant, etc.) <br />to represent ("/~A/C (name of person, company, azsociation, <br />organization, etc.) at the Pre-hearing Conference and/or Hpearing bef,f'opre the Mined Land Reclamation <br />Borad in this matter. Representative's phone number (9/L 1 O ~/~ -~~~~ ,and address <br />(Street Address) (City) ~ (State) (ZIP) <br />DATED THIS ~ DAY OF ~d/ <br />/~ ~- <br />(must be signed in blue ink) <br />If corporation attest (seal) <br />STATE OF <br />ss. <br />COUNTY OF !r s(~rYLQ~ ) <br />The foreg i g instru_ m.n~t ~waz^ dLcnowledged before me this ~~d~y of ~i //'' dd, aO0( , <br />by Its as __ ~C~t®.ib4~7tC~ o ~~iG~ /C__. <br />Y e ,'-+~~ <br />t 71'x: _ <br />( P'o <br />~`J1.1 L.iu ~~:~~ b~~Ls.i,rl'~ <br />a.rvr t <br />F"1o.~::1~1-a~~1-~~~ <br />NOT Y PUBLIC nn <br />My Commission expires: ~~S^a3'd~ <br />SIGNATURES MUST BE IN BLUE INK <br />FI:bvlpmmWwhori:Minn ~o Rrprtum a fhny.doc <br />