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9 (Form 2- Public) <br />VIII. SIGNATURE REQUIREMENT <br />Pleasejgacg you initials on the lime provided: <br />I hereby verify that the foregoing udbimation is true and accurate and cormw to the reclamation of the <br />aforementioned prospecting site as required by the Colorado Mimed Reclamation Act and the rates as specified in the <br />Hard Rod MeW Mining Rules and Regulations and this NOT 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 cmesponderwe 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 uucdentamd that I am net autbafted to create any surface disturbance until the surety amount is posted and approved <br />in writing from the Division of Reclamation, Alining and Safety. <br />I accept and agree to comply with the foregoing terms and conditions and with all of the provisions of Was 3 and S. <br />and C.R.S. 3432.101. <br />?k, om Am tame gWvw r by the MbwaLmd RAdmm dm Bawer pwmaW to sicSm 34.,MIIX CA-t, yfrge Mud La m rd <br />Redaaaat m Act Any ale radox or modl, fresdm of AlOrfem skag resaft In w &OW any NOL bsned an dw a&ved or wed <br />fen* axd sab ject Me opfvntcr to cease meat desist orders and civil for aperaftV w0 how a NOI pxomrma to secdoar 34- <br />32-123, CRS <br />L tM =kmjgwW- besing the NOI hQkjM or f person authorised to suer on behalf of the NOI balder-dc-lam that the infnrtnation <br />shm in- this NO form is true and cornet. <br />SIGNATETIM MUST BE IN BLUE INK <br />Signed and dated this JIM day of UMREO ZdIC? <br />Signature ofMI holder or permm authorized to sign: <br />z? <br />Name iris or print) A:Ixt D. Allan <br />Trtled"Osition: ?,90t , ,('ndW <br />1miMshera\,vaformg)Q7-Q7-01 vsfhaW.TM2ecgW fb msINOI Frosacong Ano. 42124107