PERMIT FILE - 3/2/2010, 7:37:18 AM-MR1

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9 (Form 2- Public) VIII. SIGNATURE REQUIREMENT Please place you initials on the line provided: G I hereby verify that the foregoing information is true and accurate and commit to the reclamation of the aforementioned prospecting site as required by the coiotado Mined Reclamation Act and the rules as specified in the G Hard RockWetal Mining Rules and Regulations and this NOI form. I have enclosed the required permit fee- l authorize the Division to contact and copy the BIM andlor USFS on any correspondence related to the prospecting G 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 audwrized to create any surface disturbance until the surety amount is posted and approved in writing from the Division of Reclamation, Mining and Safety. I accept and agree to comply with the foregoing terns and conditions and with all of the provisions of Rules 3 and 5, and CRS. 34-32-101. This foray has been approved by the Mined Land Reclamation Board pursuant to section 34-32-113, CRS, of the Mined Land Reclamation Act Any aheration or mofficadon of this form shall result in voiding any N01 issued on the altered or modified form and subject the operator to cease and desist orders and civil penalties for operating without a NOT pursuant to section 34- 32-123, C.RS I, the undersigned, being the NOI holder or the person authorized to sign on behalf of the NOI holder, declare that the information given in this N01 form is true and correct SIGNATURES MUST BE IN BLUE INK Signed and dated this _ day of Signature of NOI holdoerperson agthorrtsd to sign: I . Name (typed or print) Jack Clark, A r Owner UWAn Iha?or MV7-07-01 vs&mgdFrrsfija& prat ftMMILIZ AM- 011-407