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9 (Form 2- Public) <br />VIII. SIGNATURE REOUIREMENT <br />Please you initials on the line provided: <br />I hereby verify dot 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 rutes as specified in the <br />,,/ ` Bard Roclc/Metal Mining Rules and Regulations and this NO) form. <br />I have enclosed the mquire d permit fee. <br />I andnorize dw 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 oa the projected costs of reclamation. <br />I understand Hurt I am not authorized to (teats any surfwe disturbance until the surety amount is posted and approved <br />in writing from the Division of Reclamation, hfining 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 5, <br />and C.R.S. 34-32-101. <br />1*Jbm kw bear apprvw d by Me Mhwd Land RedammO ar Baand pmt to snow 31 32 IIX CA &, vfIkOMlaed Lwd <br />Redamedon Aix Airy adtr t or mWAPeaioa of to b form sfrell risen rn wd+Pag any N©l bsuM on the aAWed or nwdert <br />fonre and surbjea tike operatar m cmw and desist ender mod chd pares for apenmms rv+idwW a NO-1 ,pwrivoW to sedkx -U- <br />32,123, C.R.S. <br />on behalfof the I holder- laze that the infi=Wgn <br />&" in this N91 fotrn is true and gg mML <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this 141,61 day of I&RQ 2aIC) <br />Signature ofNUI holder or person authorized to sign: <br />Nam (typed or print) hdwt D. ALJw <br />ride position: F?-OIR Qn w <br />ap{ lv ? 7 07-01 vsforn3 nR f9muM amzWnnAm Sf?n4/07