ATTACHMENT A

[Preferred Format]

NEW MEXICO MINING COMMISSION

IN THE MATTER OF THE PETITION FOR

REVIEW OF THE DIRECTOR'S ACTION

DATED [ ] No.

PERMIT NO. ____________

[NAME OF PETITIONER],

Petitioner

CERTIFICATE OF SERVICE

I hereby certify that a true and correct copy of the foregoing [name of document] was [hand-delivered] [faxed] [mailed first class] to the following counsel of record on this ____ day of ____________ , 19__ and hand-delivered to the Clerk of the New Mexico Mining Commission.

[6-30-99; 19.10.14.1449 NMAC – Rn, 19 NMAC 10.2.14.1449, 05-15-2001]

HISTORY OF 19.10.14 NMAC:

Pre NMAC History: None.

History of Repealed Material: [Reserved]

Other History: 19 NMAC 10.2 Subpart 14, New Mexico Mining Act Implementation, Mining Commission Adjudicatory Review, filed 06-17-99 has been renumbered and reformatted as 19.10.14 NMAC, Mining Commission Adjudicatory Review, effective 05-15-2001.