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9 (Form I - All information for DRMS use and confidential filing) • Vlll. SIGNATURE REtJUIREMENT Please place you initials on the line provided: I hereby verify that the foregoing information is true and accurate and commit to the reclamation of the aforementioned prospecting site as required by the Colorado Mined Reclamation Act and the rules as specified in the Hard Rock/Metal Mining Rules and Regulations and this NOI form. I have enclosed the required permit fee. I authorize the Division to contaet and copy the BLM and/or USFS on any correspondence related to the prospecting operation, if the prospecting operation is located on federal public land. I have also enclosed the appropriate reclamation surety amount: or will post an amount as determined by the office, based on the projected costs of reclamation. I understand that I am not authorized to create any surface disturbance until the surety amount is posted and approved - in writing from the Division of Reclamation, Mining and Safety. I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Rules 3 and S, and. C.R.S. 34-32-101. T his form leas been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, GR.S., of Me Mitred Land Reclamation Ad. Any alteration or modification of this form shall result in voiding any NOI issued an the altered or modifred form and subject the operator to cease and desist orders and ctvii peuultiear for operating without a N01 pnrsun."t ter section 34- • 32-I23, CAS. I the undegigned being he NO-1 }toper M the c?erlort authorized to sip on behalf of the NO1 holder declare that lie information given in Otis NOI fprm is true and correct SIGNATURES MUST BE IN BLUE INK Signed and dated this day of , Li Signature of NOI holder or person authorized to sign: t,ini4Ian`, s(?>I?? £A1 vszorms?lfias?s Ea?N4?t t'rostingA.t7t??tt17_