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 duly authorized to do business in the State of Wyoming, AS SURETY, are held and firmly bound unto the State of Wyoming and the United States Secretary of the Interior in the sum of Dollars ($), lawful money of the United States, to be paid to either the State of Wyoming upon order of forfeiture by the Environmental Quality Council or to the Secretary of the Interior, United States Government upon order of forfeiture by an authorized representative of the Secretary of the Interior, 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:

Drilling Notification or
Permit to Mine or
Ten Acre Permit

Number and dated , and 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 operation 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 by the operation mentioned above, since the date of issuance, upon the following described land, as given within said permit and amendment(s) or notification,

Now, therefore, the conditions of the obligation are such that the Operator will faithfully comply with all applicable requirements of the Wyoming Environmental Quality Act, the rules and regulations promulgated thereunder, the terms of this permit or notification, and the requirements of 43 Code of Federal Regulations, Part 3600; and, 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, or pursuant to 43 Code of Federal Regulations, Part 3600 and applicable federal laws and regulations, and in accordance with the provisions of the Memorandum of Understanding between the U.S. Bureau of Land Management and the State of Wyoming.