PERMIT FILE - 9/10/2009, 12:23:34 PM-JWD

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9 (Form 2- Public) VIII. SIGNATURE MUIREMENT Fwplace you initials on the line provided: I hereby verify that the foregoing information is true and accurate and cmrartit 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. k I authorize the Division to contaet and copy the BI.M 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 m 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 5, and C.R.S. 34-32-101. This form has been approved by the Mired Land Reelaanatdon Board praguant to seeon 34-32-113, CRR, of the Mined Land Reelmatdou Act Any akuudan or modrwatka of this form shall rem& in wofifixg any NOI ixsrred on the attend or modiyred form and suNerx the operator to reuse and desEtt orders and dwpenames for operating waout a NOl pursuant to seadon 34- 31423, CRS uudersigaml Wing, the NOI holder or the person authorized to sign on behalf of the NOI holder, declare that the information given in this NOI form is trpp and correct. SIGNATURES MUST BE IN BLUE INK Signed and dated this ,10 .0 0 day of 9 0 6 9 Signature of NOI holder or person authorized to sign: Name (typed or print) 1)-9?7-,eAO 71 e,< -S Title/Positian z2 W t.1 e,0' IL\MnlsharetesUsV:01.0I vsfoMVTEI? ftffiM tcrsoe=9 Am M4io7