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9 (Form 2- Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />K 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 BL,M and/or U SFS 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 />K 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 S, <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 shall result in voiding any 1YOI issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a 1YOl pursuant to section 34- <br />32-123, GRS. <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 NOI form is true and correct <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this day of <br />96- ?Q 0 76 <br />Signature of NOI holder or person authorized to sign: <br />`.arse (typed or print) <br />i i.delpositi.on: _ G gi <br />1;`?'-_Ls????ateit?ftrrms?l%r?)1 ysF??l'_n??_ec?n?fot_rr?si'r.C?S.???afit:?,._ti't2?;s7?