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08/13/2004 10:34 9702475104 <br />DMG DURANGO OFFICE <br />PAGE <br />02/02 <br />t"""' <br />STATE OF COLORADO <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS W.IT'I~IDRAW FORM <br />In the matter of File No. M- <br />Name of dperator/Applicant and S <br />_" T request I be withdrawn from parry status <br />I request I be withdrawn from party status and I wish to address the Board at the format hearing, if <br />held, as a nonparty <br />(Please note that if a,~ objecting parties withdraw rlu or to the date set for the Board's considerattoa of dre <br />application, the application may be approved by the Office and no Board hearing held. 17tus, there will aot be <br />an opportunity for any person to address the Board on aay issues related to the application. Also, the Board is <br />not obllEated to consider any issues raised by a party that has withdrawn.) <br />Regardless of a patty status, the Division thoughtfirlly considers each issue submitted in writing to the Division and <br />provides a response to those issues in the Division's "Rationale for Recommendation ". The "Rationale" is available to <br />any person by contacting the Division. For persons who do not wish to become a party or withdraw as a party in this <br />matter, please contact the Division for infom~tation on application status. <br />(Please provide the following infortnation if you have or wish to have party status, thank you.) <br />Prinud Name Home Phone # <br />~~~ fs`d/PS~ ~,e'd`/wit ~~/ <br />Address <br />`~v~ /.~ ,r/ ~ ~ ~ a x/30 <br />City, Srau // ~~~ ,Zip Code <br />~'~yP/e a{rl ~ ~~/~Y9.s~r s7G>~, l~1P~ <br />Signature <br />Work Phone # <br />~ ~1 O) 3~1 pia <br />FAX # <br />- /3 ~aG a2~_ <br />Dau <br />R~Q~• , <br />'~!~G ~ <br />'~4~'~~p ~ra,~ ~1~4~ <br />~ Af `~%7r.F~'~d <br />,~~~0~~ <br />~~OgY <br />