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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 />yY 1 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 />t! 'Q' 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 slia/l result in voiding any NOI issued on the altered or ntodifted <br />form and subject the operator to cease and desist orders and civil penalties for operating wit/tout a A'01 pursuant to section 34- <br />32-123, C kS. <br />I 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 NO€ form is true and correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this <br />at <br />day of I&V P <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) wM&L vr' ? ??- <br />Title/Position:cry-) ? COQ <br />tU12#(?Y?t73?'?°iVStiHRtS??T`?'?-E31 VS?iZ1'7t7CIt?1'?ACZ:IJTi? t?6fF?SF?T4Qt FlttSj)CC€tii?, A,_(TD Ct7124/{l7