Know all men by these presents, that we the undersigned,
(State name of the Applicant)
(Give entity structure)
duly authorized to do business in the State of Wyoming, AS PRINCIPAL, and a corporation organized and existing under the laws of the State of Wyoming Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin , and  authorized to do business in the State of Wyoming, AS SURETY, are held and firmly bound unto the State of Wyoming in the sum of Dollars ($),   lawful money of the United States, to be paid to the State of Wyoming upon order of forfeiture by the Environmental Quality Council, for the payment of which sum, well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators, successors, and assigns.

Whereas, the Department of Environmental Quality, Land Quality Division, issued 

Permit to Mine
Ten Acre Permit
License to Explore by Dozing
Notification of Intent to Explore for Coal by Drilling
Notification of Intent to Explore Non-Coal Minerals by Drilling
In Situ R&D Testing License

Number and dated , and and permit amendment(s), numbered and dated pursuant to the application of the Principal,

Whereas, Check one of the following:

(a) This is an original bond,
(b) This is a bond in addition to previous bond(s) for the above mentioned  Choose Permit License Notification and which bond(s) remain(s) in full force and effect,
(c) This is a replacement bond for:

(1)	Bond Number Surety	Principal Dated
(2)	Bond Number Surety	Principal Dated
(3)	Bond Number Surety	Principal Dated

Whereas, said bond(s) shall cover any and all land affected or to be affected under above mentioned  Choose Permit and amendment(s) License Notification , since the date of issuance, upon the following described land as given within said (Permit and amendment(s), license, notification).

 
Now, therefore, the conditions of the obligation are such that, this bond shall remain in full force and effect until either released or forfeited pursuant to the provisions of the Wyoming Environmental Quality Act and the rules and regulations adopted pursuant to that Act.