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G <br /> AUTHORIZATION TO REPRESENT A PARTY <br /> (Please Type Or Print The Requested Information) <br /> SIGNATURES MUST BE IN BLUE INK <br /> I <br /> (person's name) (title) <br /> of (name of company, association, organization, etc.) am <br /> authorized to delegate , a <br /> (person's name) (consultant, etc.) <br /> to represent (name of person, company, association, organization, <br /> etc.) at the Pre-hearing Conference and/or Hearing before the Mined Land Reclamation Board in <br /> this matter. <br /> SIGNED AND DATED THIS DAY OF , <br /> If corporation attest(seal) <br /> Authorized Signature(must be signed in blue ink) <br /> Title: <br /> State of ) <br /> ss <br /> County of ) <br /> The foregoing instrument was acknowledged before me this day of , <br /> by as of <br /> Notary Public <br /> My commission expires: <br /> SIGNATURES MUST BE IN BLUE INK <br /> AAblkdoc\prtywve.wp <br />