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0, <br />9 <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the tine provided: <br />? 1 hereby verify that the foregoing information is true and accurate and commit to die 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 />1 authorize the 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 />- 1 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 />in writing from the Division of Reclamation, Mining and Safety. <br />1 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 />This form has been approved by the Mined Land Reclamation Boardpursuant to section 3442-113,C.R.S, of the Mined Land <br />Reclantatlon Act. Any alteration or mortification of this form sbull result in voiding any NOI issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NO! pursuant to section 34- <br />32-123, CXS. <br />I, the undersigned being the NOI holder or the person authorized to sign on behalf of the NOI holder, declare that the information <br />given in this NOT form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this ? day of a Ci / 6 $ - 4ye?ML ignatur NOI holder or person out ri d to sign: <br />Name (typed or print) <br />title/Position: _ PAV:4 _ !i- e? E zI V <br />ATE OF COLORADO <br />COUNTY OF F-r e-~ at <br />It <br />forcgoing insttrru?m-eent was aknowledod bofcwa <br />me this day of . c? xC['a11 <br /> <br />OPNYEL? <br />?.• ocARy•.•,Oq <br />Q• <br />3• <br />• ?G : QO <br />sTgTF Fg O <br />l <br />-t•1mjji shsre_vstixms1Q7-07-OL rm Tmr p c6n?r fbmgg1 0I Prosneetine App. 07/24107 <br /> <br />