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9 (Farm 2- Public} <br />VIII. SIGNATURE RE tIIREItrIE~IT <br />Please place you initials on the line provided: <br />__~~,- I hereby verify that the foregoing information is tn~e and accurate and commit to the reclamation of the <br />aforementioned prospecting site as required by the Colorada'ktined Reclamation Act and the rules as specified in the <br />Lard Roclultiietal Mining Rules and Regulations and this NOI form. <br />__~~ 1 have enclosed the required permit fee. <br />___~~~. I authorize the Division to contact and copy the $C.,iVi andtor 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 />based on the projected costs of reclamation. <br />_~e~~ 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 />a.nd C.R.S. 34-32-I01. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-3Z-713, C.R.S , of the Mined Land <br />Reclamation ttct. tiny alteration or modification of this form shall result In voiding any 1VOl issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NOI pursuant to section 34- <br />32-123, C.R.S. <br />I, the undersigned, being the NOI holder or th.e person authorized to Sian on behalf of the Iv'OI holder, declare that the information <br />given in this NOI form is true and correct. <br />SIGNATURES 1~lUST BE IN BLUE INK <br />Signed and dated this ~~„~" day of F~_.~`t`,~Q1-~~~ t~ ~...,, <br />Signature of NOI holder or person authorized to sign: <br />c_ ' <br />/~1 ~ P <br />Name (typed c~!r print) --------~s,~r-~5-------- `-- ~~_._`~_-_ '_!V __ .............. <br />..1"i.tie1'osi.tiott :.............._..........._~!z{l_'~.~'..['._ .........Q ._ ~.~:------___ _.....- <br />f.t+rtsts~sh,~~y.:~ifc~rrs~~1'-(37-~)t csf s3~~3'ruS,C,~r.i~n~.tgrz~::~?~S„f' c~s:~_.:.~?'i~'.._3a~~'..-z~..! ?~_~?~ <br />