In consideration for approval of a Limited Mining Operations Permit (10-Acre Exemption) for (Name of Operator), the undersigned hereby agrees to assume responsibility to reclaim all lands previously affected by (Name of Previous Permit Holder) under Permit (#) and to comply with applicable mining and reclamation requirements of Wyoming Statute §35-11-401(e)(vi) through (ix) and Land Quality Rules and Regulations, Chapter X for those lands previously affected and all newly affected lands.

Dated this day of ,

Title of Operator providing a signature