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9 (Fo1m 2- Public) <br />VIII. SIGNATURE REQUIREMENT <br />Please place 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 Rock/Metal Mining Rules and Regulations and this NO.I form. <br />I have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BLlvi and/or 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 />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 farm 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 NQ1 issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a 1V0I pursuant to section 34- <br />32-123, C.R.S. <br />I, the undersigned, being the NOT holder or the person authorized to sign on behalf of the NOT holder, declare that the information <br />given in this NO[ form is true and correct. <br />SIGNATURE S MUST BE IN BLUR INK <br />Signed and dated this <br />day of <br />Signature of NOI holder or person authorized to sign: <br />'Fame (typed or print) <br />"Title./Position: <br />?r; . ehk3+c crrr Ff, t? ?I1 Est 3X5-R-- . x ung, bmgn 3'ti s€,t „c„ ice: _ 7g_.!}'r?viiJ'.