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M1~D LAND RECLOMATIONB~RD III IIIIIIIIIIIII III <br />sss <br />PARTY STATUS REQUEST FORM <br />In the matter of File No. M-~-~, Permit/Pemtit Amendment Application. <br />Name of Operator/Applicant and Site: L~,unQe C'd~d7Q~U , ~RG. <br />~iue-YylPU~ I~4Gwtco~. <br />I request that I be named as a party <br />I request that I not be named as a party <br />I request to be withdrawn from pparty status 0 n bcnalf ~ F. (~. Q, N. ~ <br />'~ Lohnes, ll.~r~~n, ~Qvls, Ge~ib o~d GaSle. <br />I understand that if I am not a party, my statements of concern or objection to this <br />application will not be considered during the review of the application, but I may address <br />the Board on this matter at the final hearing, and may present my concerns as an <br />interested member of the public. <br />For people who do not wish to become parties in this matter, information on permit <br />application status can be requested from the Division of Minerals and Geology. <br />K~ <br />Printed Name <br />3U~5~ ZI t~ky l~vad <br />A,,¢¢dress <br />(~recle4, C'D fd'Xo3t-9375 <br />City, State Zip Code <br />lglal 353 - 0545 _ <br />Home Phone # <br />(2701 ;353 - O(ol I <br />Work Phone # <br />(901353 -Ofol3 <br />FAX # <br />Address <br />D3~I~L~bD <br />Date <br />If you are requesting to be named as a party, please briefly describe below: <br />1. how you may be affected or aggrieved by the Board's decision in the matter referenced above, <br />2. your opposition to the matter, including a specific description of the issues that you feel need <br />to be addressed at the final hearing. (Yoy may attach a written statement to this form instead <br />of using the space below.) <br />