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V[II. ~G~IIATURF R~, UIR <br />Please piece you initials on the line provided: <br />~_ thereby verify that the foregoing infatmation is true artd accurate and asmtnit w the raocianmtion of the <br />"~~_ aforementioned praspetxing site as tegrtired by the Colorado Mintd Rechrmatian Act and the rotes as specified is the <br />Hard RocklMetai Mining Rules and Reguiatiotts and this NOi form. <br />1 hays crrcioxd dtc required permit fee. <br />_ 4 sutharixs fire Division to emttact and enpy t~ BLM altd(ar USFS oft any sQrresporettence related to the prospecting <br />upertttiort, if the pa~spe~ag sperat#on is located on fed~ai publ~ land. <br />I have also enclasad the apprvpriane nociamatian suroty amount or will poet an amount as determined by the ott~ce, <br />based on the projected casts of reciamatian. <br />1 understand first I am not authorized to create any surface disturbarsse unlit the safety amount is posted and approved <br />in writing from the Division of Reciatrustlon, Mining and Safety. <br />I aoaept and a{pree to comply wiill the faregfsing terms and saadiiians and with ail of the pmvis~rts of Attlee 3 and S, <br />and C.R.5.3432-i0i. <br />TiYts frrmr bas baser ~ by tore Mta~ hate tlaatan~dE~ ~ possttent tr- se+mtoa 3d-,i.? 113,G~, ajMre Mirirtd land <br />RerlsrrrsatlrrA ~dc~ Aay aheraalnat or mad(Jl arr~va of tAria fora~r shaft rertelY rh w~ldGog Airy Nt?! tcs~rtd art tlkt aldrrad or nmd~e+d <br />fium eaett srr6jsd' ~a opmttar to use evtd dtsfat ord'era arrsr rhH ~taltktt, for a~rnttrr~ w~llt~t o NU! ~arstratrt W tertMtt 3~ <br />32-!?3, GRS <br />~~ I~i$ undetsisned being the NQi holder ar dte tl}Q ' ro s'y~on behalf of O! 3tol~r declare i~tt the 3ntbrma_*~~ <br />r<iyen in this 4i form is p7,{c a~ correct. <br />StiGIyATUR~ ttiitlST ®iE iA18Li1>«; fNK <br />Signed and dated this /6~ day of r;,~~~~h'Q'~ . <br />Signature of Ni?! itohles or i autbari~ed ffi sign: <br />,' <br />name (typed or print) R einy Zimbelman <br />TitlelPasition: ~~~..t ~ C.'(l9(= (:~rnnLa-1.7.073 <br />~'SatiA~stit7r~~tltYl 7 1 s~Sttt1S~R~inz fi~ra!`~4iP.k~t Ams. R7~'ja}47_ <br />