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`. ~ ST. III IIIIIIIIIIIII III ADO <br />MINED LAS.,, n~~9i r-r+la ~ ION BOARD <br />PARTY STATUS REI~UEST FORM <br />I request that I be named as a party <br />I request that I not be named as a parer <br />I request to be withdrawn from party status <br />In the matter of File No. M-~- 6Ll <br />'~ECEIVFD <br />MAY 12 1999 <br />Division oiMlne~ & ~~ <br />1091' <br />Regardless of your status, please fill in your name and address so the Division can send you <br />information on this matter. <br />It j o r~ ~ . ~ a of rl r'c ~ ~- <br />P ~ ted N e <br />Addr s <br />(a ~~ ~ ~535~ <br />City, State Zip Code <br />Y~y - ~7G~ <br />Home Phone # <br />c ~ - <br />Work Phone # ~~~ <br />r ~ <br />FAX # f7o -~P~- O~U J <br />1 C~ ~~~ <br />Signa re <br />5//~~ <br />D tae <br />If you are requesting to be named as a party, pleas: briefly descr'be belew hcw you may be <br />affected or aggrieved by agency action in the matter referenced above. Include a statement of <br />your opposition or support in the matter. You may ab:ach a written statement to this form instead <br />of filling in the space below. Include a specific description of the issues that you feel need to be <br />addressed at the final hearing before the Mined Land F.eclamation Board. <br />l~~ "-~ ~ ^o-c w~4+-~ tJ ~G2 Ccra~c~e a.~ ~e~f~ lid <br /> <br />- v-,,t v tsr,- u.,An .p_.~ ~ ~- <br />~re-r lip ~~ ~ A1-14 a a b~(,-af,-a ~ ~ W r J~o,~~X../._2 <br />2 (1 nn -A-- _ .- i Il-~ ~L <br />