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9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />hereby verify that the foregoing information is hoe 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 />1 have enclosed the required permit fee. <br />7Y 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 />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, C.&S , of the Mined Land <br />Reclamation Act. Any alteration or modification of thin form shall result in voiding any NOI issued on the altered or mod fed <br />fore: and subject the operator to cease and desist orders and civil penalties for operating without a NO] 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 NO1 form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this & I- day of v "'??v 1 , <br />? <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) (U\ S a n <br />Title/Positiot]3- e GJ ?nA7 M Cen` <br />tiU <br />.;,X117#IIIY { "V Qfj73 R 7.0141 VSfQrmtJ' Q$ {,t"IIYIL IDfp4S'INOt lsrg3 ehne Anp. [Y7/24JQT