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9 (Form 2-Public) <br />VIII. SIGNATURRE .REQUIREMENT <br />Plea~se,~place you initials on the line provided: <br />t~s/~V---•- I hereby verify that the foregoing information is tn~e and accurate and commit to thy; reclamation of the <br />aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br />Bard Itock/Metal Mining Rules and Regulations and this .NOI form. <br />i~ , 1 have enclosed the required permit fee. <br />i~~~~-•- I authorize the Division to contact and copy the ALIVi and/or USPS on any correspondence related to the prospecting <br />~ ~~ operation, if the prospecting operation is located on federal public land. <br />r'Js?~l-•-.- I have also enclosed the appropriate reclamation surety amount or will post an amount as determined by the office, <br />~I based on the projected casts of reclamation. <br />~'~! I understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved <br />/~ in writing from the Division of Keclamatiott, Mining and Safety. <br />/~~Y_ ~_• 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.R.S. 34-32-101. <br />This form has been approved by the .'lined Land Reclamation Board pursuant to section 34-32-113, C.R.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any ~'VOI issued on the altered or modifted <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NOI pursuant to section 34- <br />32-123, C.R S. <br />I, the undersigned, being the NOI holder or the person authorized to sign on behalf of the IvTOI 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 ~~ day of ~ ~ ~ , <br />Signature of NOI holder or person authorized to sign: <br />i <br />----- - ' ~_`J <br />Name {typed or print) ~~'e~_._.t,-~.- ~9.~.~----------------------._........ <br />'I"ttleJPasitirn3:.Q r..__. - ---._... S'`~.,~c1:5 ... _ <br />4:t~,.i~l~~re~vg,#:s?rm~~~)7~7~} 1_v~1e~3~~`~I'rt~~~sec[inf.f~~t'mK?:'vt~~..k'T5?sp&:~:};in8.<~.pg....~ 7`4~JII.1 <br />