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9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the tine provided: <br />I 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 />I have enclosed the required permit fee. <br />Wky I authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br />2" operation; if the prospecting operation is located on federal public land. <br />1 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 I,v the iWirted Land Reclamation Board pursuant to :section 34-32-113,0 XS., of the ,dined Land <br />Reclamation Act .arty alteration or modification of this fornx shall result in voiding any NOI issued on the altered or nxodyl-ed <br />fornx and subject the operator to cease and desist orders and civil penaUiPs for operating without a tV01 pursuant to section 34- <br />32-123, C X 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 />Signed and dated this 0- day of LA? , <br />t <br />Signature of NOi holder or person authorized to sign: <br />Name (typed or print) _ M aC t C 'W V1,&-- <br />Title/Position: _ ?i°.rr?M-? f u?t? ? 1v? J-& 12- E n y i rb n ?'r.Q,r, •C Ce ?'?S t-+? ? <br />r <br />t inVYharetvsfcnp 7 Q7 Q1 vSfgr?,slPY-mtjpg formsNO1 Prospecting Apo. 07/2410