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9 (Fonn 2- Public) <br />VI11. 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 />I lard Rock/Metal Mining Rules and Regulations and this NOI form. <br />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 proiected 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 i, <br />and C. R.S. 34-32-101. <br />This firm has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, C.R..S., of the Alined Land <br />Reclamation Act. An?• alteration or modification of this form shall result in voiding a?it• NOI issued on the altered or mollified <br />firm and subject the operator to cease and desist orders and civil penalties for operating without a A701 pursuant to section 34- <br />32-123, C.R..4. <br />I, the undersigned, being the NOI holder or the person authorized to sign on behalf of the NOl holder, declare that the information <br />given in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />1-4 <br />w-l <br />Signed and elated this J? day of' 4-b Oe <br />Signature of NOI holder or person authorized sign: <br />Name (typed or print) A41- L y (.67 <br />Title/Position: <br />I ?L min\share\vsforms\07-07-01 vsformsTrosNcting Iiomis\NOI Prospecting Apt). 07/24/07