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9 (Form 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 BLM 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 />1 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 />-A6w 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 34-32-113, C.R.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this farm shall result in voiding any NOl' issued on the altered or mod fed <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, CR.S <br />1, the undersigned, being the NOT holder or th.e person authorized to sian 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 ,0 <br />Signature of NOI holder person authorized to sign: <br />1-52 / .. _ 4 A <br />Tame (typed or print) <br />??-_ <br />1°i.tleIPosition: _.__.._..._...__._M_......._.........._._...-........ Rd F0,. ?111 F,-, --, <br />i . <br />AUG 3 ; ZU09 <br />Division of Kei tatYia[tiit <br />Mining and Safety