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(FORM 2 - Public filing) <br />VIII. SIGNATURE REQUIREMENT <br />Please place you initials on the line provided: <br />p� c 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 NOI form. <br />I have enclosed the required permit fee. <br />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 />COY I 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 />D C2 <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 />I herby certify that concurrent with submittal of this NOI 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 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 NOI pursuant to section 34- <br />32-123, C.R.S. <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 />Oven in this NOI form is true and correct. <br />SIGNATURES MUST BE IN BLUE INK <br />Signed and dated this C� &I, day of <br />Signature of NOI holder or person authorized to sign: <br />Name (typed or print) DGi .41 / e / r� t? u% / s <br />Title/Position: 0 L-) Yl �V` <br />