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<br />9 (Form 2-Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />i_ I hereby verify that the foiegoing information is true and accurate and commit to the reclamation of the <br />aft prospecting sine as required by the Colorado ?dined Reclamation Act and the rules as specified in the <br />Hard Roclv'hietal !+~tining Rules and Regulations and this NOI form. <br />t:F~ I have enclosed the required permit fee. <br />~~_ I aut>uxiae the Division to contact aatd copy the BLM andior USFS on any correspondence related to the prospecting <br />operation, if the pr+ operation is on federal public land. <br />~~/°J I have also ~cMsed the appt~priaoe rectaaratior~ Surety arnonnt ~ wr`T! post an aawunt as determined by the office, <br />based oa the priojected costs of reclamation_ <br />~~ I ande~and flrat I am not authmizod to crea0e aay surface disturbance until the surety amount is posted and approved <br />in writigg from dar Division of Reclamation, ?4lirting and Safety. <br />I accept acrd agree w Damply with the forego~g tents and cmditions` and with all of the provisions of Rules 3 and 5, <br />and C.R.S. 3432-I01. <br />T~ Pones ies ~ ilppr~vsoad by dit gttwd I.rwd ~ Bosiad prs~t to saxiox 3~1d2--113, GSS, of die Mixed Laid <br />Badae~t Ad Asy ~e~w or ror~oetiiss ~'~risFors~ s/roit sra~dt nr spa mey NOI isaaed oa die ahered or modified <br />f~ owd ~~ ~ ~ cserse cud deatflt orders wrd gull parr~its for apaemuig rvidiawt a NOI prrrsiraxt to secyiox 34- <br />32-123, GRS <br />I, fire uadeasitmed. being the iYOI holdex or fire person authorized to sign on behalf of the NOI holder declare that the information <br />liven is this NOI form is taste and cameo. <br />SIGIITATURE.S MUST BE IN BLUE INK <br />_-~- <br />Signedand datcd this 2/ s j dayof i/~~. y ,,Z C~7~ <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) G.-/-!->r-c /, j~,t,» <br />T"rtlelPosition: _~~ /~c~~.~i~S ~~~-~,...r.~ <br />~vr~a's~tssf'cxr~'1}?-(37-f?I vsfwmsi?msr~+n~,,g~rsis~l4`~•r P~oso~er~~,~+a. ~7t2~i,~ <br />