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VIII. SIGNATURE REOUIREMENT <br />Please place you initials on the line provided: <br />arN <br />9 (FORM 2 - Public filing) <br />I hereby verify that 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 rules as specified in the <br />Hard Rock/Metal Mining Rules and Regulations and this NOl form. <br />.y., l 1 " I have enclosed the required permit fee. <br />,,, ><r I 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 />4' T 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 />.,,f.�' 1 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 />,,,r T 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 />1 herby certify that concurrent with submittal of this NOl to the Division, I have sent notice to the Boards of County <br />Commissioners in the Counties where the proposed activities will occur. This notice also indicated that non- <br />confidential information regarding the proposed activities will be available for review at the Division's website. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34 -32 -113, C.R.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any NOl issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a NOl pursuant to section 34- <br />32 -123, C.R.S. <br />L 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 NOl form is true and correct. <br />Signed and dated this August 16 day of 2 011 <br />Signature of NOI holder or person authorized to sign: <br />SIGNATURES MUST BE IN BLUE INK <br />Name (typed or print) Michael DeBerry <br />Title/Position: Rockies Area Manager <br />