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AUTHORIZATION TO PRESENT A PAI2TX <br />(Please Type Qr Print The Requested Int'ortnation) <br />STGNATUT2FS MUST BE Itii' BLUE INK <br />I <br />(person's name) (title) <br />of (name of company, association, organization, etc.) am <br />authorized to delegate <br />,a <br />(person's name) (consultant, etc.) <br />to represent (name of person, company, association, organization, <br />etc.) at the Pre-hearing Conference and/or Hearing beforo the Mined Iaad Reclamation B oard in <br />this matter. <br />SIGNED AND DATED TIIIS DAY OI' <br />If corporation attest (seal)' <br />Authorized Signature (must tie signed in blue ink) <br />Title: <br />State of ) <br />ss <br />County of ) <br />The foregoing instrument was acknowled;ed before me this day of , <br />by as of <br />Notary Public <br />My commission exp'ues: __~_„ <br />SIGNATURES MUST BE LN BLUE INK <br />awu~aa~v~~wa <br />Z57-d 600/EOO d Z5Z-1 901EZE5E0El+ aea~oeg 9 s~eaeuiw }o uaisini0 apeial~J-VN08d !2 5l 5002-J30-ZO <br />