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• • III IIIIIIIIIIIII III <br />AUTHORIZATION TO REPRESENT .a PARTY <br />(Please Tvpe Or Print The Requested Information) <br />SIGN.4TtiRES ~bILST BE IN BLUE INK <br />I ~~blcr/ YV . RI ~Dr~ <br />(Person's Na <br />(Title) <br />of (name of company. association, organization, etc.) am <br />authorized to delegate Lort ~G I ler , a c~Or <br />~'Dp (Person's Name) ( onsultant. e[c.) <br />to represent ~YLIC:. ~,~. /\I :at . (name of person, company, association, <br />organiza[ion, etc.} at the Pre-hearing Conference and/or Hearing before the ivlined Land Reclamation <br />Borad in this matter. Represen[ative's phone number (i0"(1 24b - `iYI:L ,and address <br />I`4~ I I~'~ S'~re,,,~. St;.,1'z :S~~t~ ~knveY CO , ~~21;~. <br />(Street Address) (City) (State) (ZIP) <br />SIGNED AND DATED THIS I 1 +~' DAY OF 1~? r, ~ ?Gu 1 <br />I1 W, ~ ~ <br />o /11:<.a~ Jed / If corporation attest (seal) <br />Authorized Signature (must be s ed in blue ink) <br />Title: <br />STATE OF ~~'1~rlt~t= <br />) SS. <br />COUNTY OF LGi 't />1~ ~ ) <br />The fcoregoin~ inswment was acknowled_eed before me this I I }~ day of ~ r` I . 2~=1 . <br />NOTARY PUBL C <br />:~(y Commission expires: A7y Cemmi55t~n EzoitES 1 ~ =003 <br />r_'~n ,~_ <br />i.:.:. `.:~,:... .. .... ~:. ~ <br />SIGNATURES ~IC'ST BE IN BLUE INK <br />M bssb~nznUwhenzauon m R<presev s Pmy Jac <br />