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IN WITNESS WHEREOF, the parties hereto have caused these presents to be duly executed in triplicate by their proper officers the day and year first above written. [[blank line]] Purchaser [[blank line]] [[blank line]] Address THE UNITED STATES OF AMERICA [[blank line]] Director, Bureau of Mines. APPROVED: [[blank line]] Secretary of the Interior. I, [[blank line]], certify that I am the [[blank line]] secretary of the corporation named as the purchaser herein; that [[blank line]] who signed this contract on behalf of the purchaser, was then [[blank line]] of said corporation; that said contract was duly signed for and in behalf of said corporation by authority of its governing body, and is within the scope of its corporate powers. [[blank line]] Corporate seal APPLICATION TO PURCHASE HELIUM FROM UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF MINES This space is for recording by the Bureau of Mines and is not part of the application. Application No. [[blank line]] Date [[blank line]] Received [[blank line]] Rejected and applicant notified [[blank line]] Report prepared and contract sent applicant [[blank line]] Name of Applicant [[blank line]] (use name under which contract is to be made) Address [[3 blank lines]] Date [[blank line]] 6263 -16-
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