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<br />STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAWAL FORM <br />1i Permit/Permit Amendment Arlic, <br />In the matter of File No. M---7 <br />Name of Operator/Applicant and Site: <br />I hereby withdraw as a party to this matter. <br />I hereby withdraw as a party to this matter and, if the Board holds a hearing, I <br />wish to address the Board at the formal hearing, if held, as a non-party. <br />(Please note that if all objecting parties withdraw prior t the d ttheet for he thud's the <br />consideration of the application, the application may approved by address the Board on any <br />Board holding a hearing. In that event, there will be no opportunity to issues related to the application. Also, the Board is not obligated to consider any issues raised by <br />a person or an entity that has withdrawn as a party.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing <br />to the Division and provides a response to those issues within its jurisdiction in the Division's <br />"Rationale for Recommendation." The Rationale is available to any person by contacting matter, <br />Division. For persons who do not wish to become a party or withdraw as a party <br />please contact the Division for information on application statuss../ <br />Pri d Name Home Phone # / .._ ._ <br />A - ss Work Phone # G? J <br />Zip Code FAX # <br />City, St to <br />E it Addre V Date <br />12