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ARTY STATUS WITHDRAWAL FORM <br />In the matter of File No. M . VA \ . \C6 <br />Name of Operator/Applicant and Site: ' <br />I hereby withdraw as a party to this matter and, if the Board holds a hearing, I <br />wish to address the Board at the formal hearing, if held, as a non - party. <br />(Please note that if all objecting parties withdraw prior to the date set for the Board's <br />consideration of the application, the application may be approved by the Office without the <br />Board holding a hearing. In that event, there will be no opportunity to address the Board on any <br />issues related to the application. Also, the Board is not obligated to consider any issues raised by <br />a person or an entity that has withdrawn as a party.) <br />Regardless of a party status, the Division thoughtfully considers each issue submitted in writing <br />to the Division and provides a response to those issues within its jurisdiction in the Division's <br />"Rationale for Recommendation." The Rationale is available to any person by contacting the <br />Division. For persons who do not wish to become a party or withdraw as a party in this matter, <br />please contact the Division for information on application status. <br />S ot\ Kro■vS <br />I hereby withdraw as a party to this matter. <br />Pritited Name <br />Address ( AKewcA Co M3 <br />City, State - G <br />�. ' ANA e...r\ o S ` A,\ c�J` . LOZip � Code <br />E-Mail Address A) own , ) 1 J <br />Signature <br />D <br />Dlvi Duran ie4 <br />Mini an d S o f ;-n <br />Y <br />STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />12 <br />Permit/Permit Amendment Application. <br />nli o J <br />x,03, 8 -via(, <br />Home Phone # <br />t ) <br />Work Phone # <br />{ <br />FAX # <br />Date <br />14belle..1kino 114(Ae 6pAple..)4 <br />4-19i31 <br />-o/ <br />RECEI1VM <br />DEC 01 2011 <br />Division of Reclamation, <br />Mining and Safety <br />