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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 NOI form <br />I have enclosed the required permit fee. <br />I authorize the Division to contact and copy the BI.M 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 />JU <br />in writing from the Division of Reclamation, Mining and Safety. <br />l) 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 />Thi's form has been approved by the Mined Land Reclamation Board pursuant to section 34-32- -113, CRS, of the Alined Land <br />Rerlaenaden Act Any akeretion or modUkadon of this feral shall resuk in voiding any ,VOI issued on the altered or m*AYred <br />foray and subject the operator to cease and desist orders and civll penalties for operaling without a NOlparsuant to seedion 34- <br />32 -123, C-Jt& <br />I the unde sign2l being the NOT holder or the pWon auth ryPd to sign 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 LNK <br />Signed and dated this day of ��� - -aMcR- <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) �c� t�rtiv� G,e�S,e <br />Title/Position: 4RWA(I1-i (9 R R T ,WC <br />