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~ ~4 j,. <br />9 (Fotrn 2-Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the tine provided: <br />I hereby verify that the foregoing information is true and accurate and cottunii to the reclamation of the <br />aforemention$d prospecting site as required by the Colorado ;4Sined Reclamation Act aid the rules as specified in the <br />Hard Rock,'Metal Mining Rules and Regulations and this NOI form. <br />j~/S I have enclosed the required permit fee. <br />~_ I authorize the Division to contact and copy the BIM and/or USFS on any conrespondence related to the prospecting <br />operation, if the prospecting operation is located on federal public land. <br />~~~ I have also enclosed the appropriate reclamation surety amount or will p -st an amount as determined by the offtce, <br />~^ based on the projected costs of reclamation. <br />C . /~~S I understand that I am not authorized to create any surface disturbance unti(the surety amount is posted and approved <br />is wtitiag from the Division of Reclamation, Mining and Safety. <br />~~ I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and 5, <br />and C.RS. 34-32-101. <br />This form has bear approted by tke Miaed Lard ~ Board psrsxaat to saxiow 3L-32--113, CRS, of the Mfireod Load <br />Recatauration Act Aay alter+asfow ar rsetiot: of tl4is Jmsr slfr~tl resuGt is s~rt~g axy NOI as~tred ou tAre aina~ or modified <br />fora aAd sabjed the operator to cease wad daast orde-s aad a~T paealtees for opa>~g ~IGevt a NOI prrrsp~t to sactdow 34 <br />32-IZ.I, GRS <br />tK the undersigned. being the NOI holder or the person autlwrizeli to sign on behalf of the NOI holder declare that the information <br />given in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this ~/ s~ day of ~ ~~-5~ Zcx~~ , <br />--~-- <br />Signature of NOI holder or person authorized to sign: <br />e~ <br />Name (typed or print} ~~.~. ,~. ,,~/'ra,c%/ <br />TitlelFositian: ~/°G~ig7o.~s ~s.~/~'-,c.~~}~,~,~ <br />t <br />- ~ <br />r_~~~~s_:,-:Gr,--m.~~-er-oi ~L~om~~aro=t~rr~~~ ozna,~ <br />