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9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line 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 Mitred 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 />r 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 />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 />77tis form Itas been approved btu the Milted Land Reclamation Roard pursuant to section 34-32-113, C.R.S., of Me Mined Land <br />Reclamation Act. Any alteration or modification of t1tis form shall result in voiding any iVO1 issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating witliout a tV01 pursuant to section: 34- <br />32-123, CRS. <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 />even in this NOI form is true and correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this ? O ]E!- day of <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) Mas- J_ <br />Title/Position: Eo Vi <br />C" S(iw -s- <br />(?rn?Q?-nr?;vs__ ti r?rr?s407-Q7?' i vcformslf'rrsn?c-tirig ortns`,itiEQt Pro?txrtine At?n. Ct7l2?t