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<br /> <br />reclamation only if the '_oard nas determined: <br />i. tnat reclama*_ion required by law to <br />have teen p2rfOfineC upon such ldnds has nOt been perfOfineC. <br />and <br />ii. that financial ,.arranty forfeiture <br />CrOCe2diny; 02;Crib2d in ih2 act or similar DrOViSiOn; of <br />;uD;2yu2nt la.+;. If any. helve peen initiated. <br />5. Tne ad::itional stipulations set forth in the <br />at2aCh2d rider. if any. dre iDCOr pOr atetl her2ln by ref erenCe. <br />/____/ ?) Rider is attached. <br />/_~/ b) No rider i; attacneC. <br />aCCE~TEJ a`:J a;,REEJ: <br />Dp~rator <br />MINE) LaNC RE~LaMaTICN °O:.RJ <br />`+I^lEJ LA`1C RE=La,MaTI G'1 DIVISION <br />i.GLGRaDO GEPAnTMENT 7'r <br />NaTURaL RESGURCES <br />/%d ,Slur~- <br />Division Dir2CtDr <br /> <br />Notarization of ~p2rator's acknodl2dGment <br />STaTE__ <br />-_ _r________1 <br />) 55. <br />Tne for2goiny- instrument aa; 3cRnc~.+lao;eel before me <br />ini; ~~_ cay of ~y~_____. 193Z by ___ as _ of _. the operator. <br />---m = -~~•'~-~ ------------- <br />`iJTaRY ~U Lf~ <br />-L- <br />