Surety Bond Form

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
Land Quality Section
Bond Pursuant to "The Mining Act of 1971"
(G.S. 74-46 through G.S. 74-68)
KNOW ALL MEN BY THESE PRESENTS, that
a and having its principal office at
in the State of , as principal, and
a corporation organized under the laws of the State of and duly authorized bythe
Insurance Commissioner of North Carolina to do business in North Carolina, with an office located at
, in the City of North Carolina, as surety, are held and firmly bound
unto the State of North Carolina in the sum of Bond No.
lawful money of the United States of America, to the payment of which will and truly be made, we bind
ourselves, our heirs, administrators and successors jointly and severally, firmly by these presents.
Signed, sealed and delivered this day of , 20_
THE CONDITIONS OF THIS BOND ARE SUCH, That Whereas, the said
conducts or will conduct mining operations in North Carolina as described in the application for an operating
permit which includes a Reclamation Plan as provided in G.S. 74-53 and has obtained approval of this
application on the day of 20 , from the Department of Environmental Quality.
Rev. Dec 2006

NOW THEREFORE, if the said
shall comply with the requirements set forth in "The Mining Act of 1971"(G.S. 74-46 through 74-68)and with
the rules and regulations adopted pursuant thereto and faithfully perform all obligations under his approved
Reclamation Plan then this obligation shall be null and void; otherwise to be and remain in full force and
effect until released by the Department of Environmental Quality in accordance with G.S.74-56 or canceled
by the surety. Cancellation by the surety shall be effectuated only upon 60 days written notice thereof to the
Department of Environmental Quality and the operator as provided in G.S. 74-54.
ATTEST:
Secretary or Principal
Assistant Secretary
( Attach ) By
( Corporate Seal ) President, Vice President,
( here of Corporation ) Partners, or Owner
S u rety
Countersigned at North Carolina
By:
Resident Agent of NC Agent and Attorney in Fact
*PLEASE MAIL THIS FORM AND THE ATTACHED INSTRUMENT
TO THE FOLLOWING ADDRESS:
LAND QUALITY SECTION
1612 MAIL SERVICE CENTER
RALEIGH, NC 27699
Page 2 of 2
Rev. Dec 2006