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9 (Form 2- Public) <br />VIII. SIGNATURE RE Q IREMENT <br />Please ce 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 RocldMetat 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 BLM and/or USFS on any correspondence related to the prospecting <br />ration, if the prospecting operation is bated 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 />n <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 34-32413, C: RI, of the Mixed Land <br />Reclamation Act Any aheranon or modifteation of this form shall result in voiding any NOI issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penaldes for operating without a NOlpursuant to section 34- <br />32-123, C.RS <br />I the undersigned being the NOT 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 O? <br />Signature of NOT holder or person authorized to sign- <br />Name (typed or print) <br />L/ d _?GUI ,f <br />TitleMosition:. <br />Zj vgfri?Pxosc fcmr?a'f?ans Ana. i)'i24,ff?