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9 (Form 2- Public) <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 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 />?- I authorize the. Division to contact and copy the BLlvi 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 />T based on the projected costs of reclamation. <br />1 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 secdon.34-32=113, GR.'S, of the Mined Land <br />Reclamation Act Any alteration or modification of this form shall result in voiding any NOI issued on the altered or modifted <br />form and subject the operator to cease and desist orders and civil penalties for operating withouta NOI pursuant to section 34- <br />32-123, C.R.S. <br />L the undersigned, being the NOI holder or the person authorized to sign on behalf of the NO[ 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 day of C? <br />Signature of NOI holder or person authorized to sign: <br /> <br />Name (typed or print) _j3r?t'f? <br />'T'itle/Position: <br />t tY?iC S ? `1v ?QL?? % ? .! v ?i3 `_?.- I? t??? Fgrmtc'rE}d P ,3,5vec2in .,Sw 07r24i 7