Form DMM-169 "Certificate of Deposit" - Virginia

What Is Form DMM-169?

This is a legal form that was released by the Virginia Department of Mines, Minerals and Energy - a government authority operating within Virginia. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the Virginia Department of Mines, Minerals and Energy;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DMM-169 by clicking the link below or browse more documents and templates provided by the Virginia Department of Mines, Minerals and Energy.

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Download Form DMM-169 "Certificate of Deposit" - Virginia

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Division of Mineral Mining
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
(434) 951-6310
CERTIFICATE OF DEPOSIT
Permit Number:
Bond:
Performance Bond for
.
The accompanying instrument, Certificate of Deposit No.
in
the amount of $
constitutes the performance bond for the
aforementioned company under [CHECK ONE ONLY]: □ Permit Tracking Number or □ Permit
Number _____________, pursuant to § 45.1-183 of the Code of Virginia, as amended, and 4 VAC
25-31, the Virginia Reclamation Regulations for Mineral Mining .
This letter certifies that the aforementioned instrument is not and will not be considered as,
or used as, collateral for any other purpose by the undersigned institution.
Further, without the actual presentation of the original instrument to the undersigned
institution, the institution shall not authorize the withdrawal of, encumbrance, transfer of funds
from, or allow the redemption of said instrument without the expressed written consent of the
Department of Mines, Minerals and Energy, Division of Mineral Mining (DMM) of the
Commonwealth of Virginia.
It is further certified that the undersigned institution shall notify the DMM and the Permittee
of any notice received or action filed alleging the insolvency or bankruptcy of the undersigned
institution, or alleging any violations, which could result in the suspension or revocation of the
institution’s charter or license to do business.
BY:
For:
.
Name/Title of Institution Official
Name of Institution
Address:
Telephone: (
)
.
Notarization -
Subscribed and sworn/affirmed to before me by ________________________________________, this
________ day of ____________________, 20____, in the City/County of _________________.
(Seal)
.
Notary Public
My Commission expires
, 20
.
DMM-169
Rev. 06/16
Division of Mineral Mining
900 Natural Resources Drive, Suite 400
Charlottesville, VA 22903
(434) 951-6310
CERTIFICATE OF DEPOSIT
Permit Number:
Bond:
Performance Bond for
.
The accompanying instrument, Certificate of Deposit No.
in
the amount of $
constitutes the performance bond for the
aforementioned company under [CHECK ONE ONLY]: □ Permit Tracking Number or □ Permit
Number _____________, pursuant to § 45.1-183 of the Code of Virginia, as amended, and 4 VAC
25-31, the Virginia Reclamation Regulations for Mineral Mining .
This letter certifies that the aforementioned instrument is not and will not be considered as,
or used as, collateral for any other purpose by the undersigned institution.
Further, without the actual presentation of the original instrument to the undersigned
institution, the institution shall not authorize the withdrawal of, encumbrance, transfer of funds
from, or allow the redemption of said instrument without the expressed written consent of the
Department of Mines, Minerals and Energy, Division of Mineral Mining (DMM) of the
Commonwealth of Virginia.
It is further certified that the undersigned institution shall notify the DMM and the Permittee
of any notice received or action filed alleging the insolvency or bankruptcy of the undersigned
institution, or alleging any violations, which could result in the suspension or revocation of the
institution’s charter or license to do business.
BY:
For:
.
Name/Title of Institution Official
Name of Institution
Address:
Telephone: (
)
.
Notarization -
Subscribed and sworn/affirmed to before me by ________________________________________, this
________ day of ____________________, 20____, in the City/County of _________________.
(Seal)
.
Notary Public
My Commission expires
, 20
.
DMM-169
Rev. 06/16