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` ~ ~ RECEIVED Y• • " STATE GF CC~LORr.DO MINED LAND RECLAMATION BOARD MAR 0 1 2001 I request that I be named as a party I request I be withdrawn from party status cTkA' 7 I request that I not be named as a party I understand that I have party status I wish to address the Boazd at the formal hearing, if held, as a non-party nlvY~Ic4„ ~~~~ ,~,~~uu (Please note that if all objecting parties withdraw np 'Or t0 tke date set for the Division's recommendation for approval or denial, there may not be an opportunity for any person to address the Board on any issues related to the application. If all objecting parties withdraw their objection after the above referenced date, the Board may still hold a formal hearing, however the Board is not obligated to consider any issues raised by a party that has withdrawn.) Regardless of a party status, the Division thoughtfully considers each issue submitted in writing to the Division and provides a response to those issues in the Division's "Rationale For Recommendation ". The "Rationale" is available to any person by contacting the Division. For persons who do not wish to become a party or withdraw as a party in this [natter, please contact the Division for information on application status. (Please provide the following information if you have or wish to have party status, thank you.) Printed Name Home Phone q ( )_ Address Work Phone # ()- City, State Zip Code FAX q E-Mail Address Date Signature If you are not now a party and you wish to be named as a party, please provide the following: • How you may be affected or aggrieved by the Boazd's decision if the Board decides to approve the application. (Please attach additional pages if needed) • Please explain your opposition to the matter, including a specific description of the issues that you feel need to be addressed at the Formal Boazd Hearing and why. (Please attach additional pages if needed) Division of Minerals and Geology PARTY STATUS FORM