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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 RockiMetal Mining Rules and Regulations and this NOI form. <br />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 pr-specting 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 I 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 lWas been approved by the Mined Land Reclamation Board pursuant to section 34-32-113,CR.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any 1VOI Issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a iY01 pursuant to section 34- <br />32-123, C.R.S. <br />1, the undersigned, being the NOI holder or the person authorized 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 />9 tdr <br />Signed and dated this ?? day of QC?O? <br />Signature of NO der or pe n authorized to sign: <br />11 Name (typed or print) <br />???en?_:__.. . ` .___. <br />Title/Position: _... JT ?_...r...... _?._._.. __.___._..._.__.___ <br />f !tt;l lyisttt ;yst?2!T islii7-tl?r I._Ysfww,!f'i"y_ Are ftyttt dC t j'rt tut[ing ew-P- t-24 ?