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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 />--Y-` =? 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 />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 Reclamation, Mining and Safety. <br />1 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 Boardpursuant to section 34-32-1I3,C.&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 modifed <br />fora: and subject the operator to cease and desist orders and civil penalties for operating without a A101 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 NOT 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 />Name (typed or print) M& It ?!)OIN <br />LA? <br />Title/Position:'Pe4- A* aXC?? <br />11 mi \share'MformlW7.07-01 vsfgmis_U'rasMting femisNO1 ewsnectina App. 07/24107