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9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the tine provided: <br />--i-?e••'Qi`°- 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 NO[ form. <br />I have enclosed the required permit fee. <br />-IY t authorize the Division to contact and copy the BLM and/or USFS on any correspondence related to the prospecting <br />?n operation; if the prospecting operation is located on federal public land. <br />__I Y_1t 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 lire Mined Land Reclamation Board pursuant to section 34-32-113,C.&S., of the Mined Land <br />Reclamation Act. Airy alteration or modification of this form sl:all result in voiding any NOI Issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties fur operating without a N01 pursuant to section 34- <br />32-123, C.R.S. <br />I the undersip-ned, 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 />sfi <br />Signed and dated this a I day of , <br />Signature of NOI holder or person authorized to sign: <br />G? VW <br />Name (typed or print) <br />Title/Position: <br />m,N "N\,4-J <br />t.t?wsfctrms407-tt7 01 vsfpn isU rosg -I' rn 'NQI Prosuccting App, 07/24/07