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~m-r~i <br />STATE OF COLORADO ~Li; 'J ~ ZGJ5 <br />MINED LAND RECLAMATION BOARD <br />PARTY STATUS WITHDRAW FORM <br />In the matter of File No. M-1999- t 20 , PerntidPerntit Amendment Application. <br />Name of OperatorlApplicant and Site: L.6. EVERtS7- f ntC / F~Rr Ltlf ant St9Tt~ <br />I request I be withdrawn from party status <br />_ I request I be withdrawn from pazty status and I wish to address the Boazd at the formal hearing, if <br />held, as a non-party <br />(Please note that if all objecting parties withdraw np •or to the date set for the Board's consideration of the <br />application, the application may be approved by the Office and no Board hearing held. Thus, there will not be <br />an opportunity for any person to address the Board on any issues related to the application. Also, the Board is <br />not obligated to consider any issues raised by a patty that has withdrawn.) <br />Regazdless of a party status, the Division thoughtfully 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 information on application status. <br />(Please provide the following information if you have or wish to have party stems, thank you.) <br />~aSS $~~c,of~r ~~s~- 2ais <br />Printed Name Home Phone # <br />1~~"66 WCR I S <br />Address <br />~_ LNptoh C o B o62 ~ <br />City, Sta~~ Zip Code <br />E-Mai Address <br />tgnazure <br />Work Phone # <br />FAX # <br />~~t3/O 5 , <br />Date <br />