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9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />1 hereby verify that the foregoing information is true and accurate and commit to the reclamation of the <br />aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the <br />Hard Rock/Metal Mining Rules and Regulations and this NOI form. <br />_Z4 I have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BLM and/or USFS on any correspondence 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 post an amount as determined by the office, <br />based on the projected costs of reclamation. <br />1 understand that 1 am not authorized to create any surface disturbance until the surety amount is posted and approved <br />in writing 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.R.S. 34-32-101. <br />This form has been approved by the Mined 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 NOI Issued on the altered or modified <br />form and subject the operator to cease and desist orders and civilpenalties for operating without a NOI pursuant to section 34- <br />32-123, CR.S. <br />the undersigned being the NOI holder or the person authorized to sien 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 19th day of May, 2008 , <br />Signature of NOI holder or person authorized to sign: <br />-]?) e„ ?amuX?- ----- -- <br />Name {typed or print} <br />'T'itle/Position: _Agent <br />-- %n . Ct 1 G <br />t'vnm h net s# ?ru u?•t)7 }2 v. ns?rs3 t'' in forn __ Pre.-