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-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following <br />terms and conditions: <br />All necessary approvals from local government have been applied for (Rule 1.6.2(1) and (2)); <br />2. This entire mining operation will not extract more than 70,000 tons of mineral, overburden, or combination thereof in any <br />calendar year (defined in Rule 1.1(24)); <br />3. This mining operation will not adversely affect the stability of any significant, valuable and permanent man -made structure(s) <br />located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the applicant/operator and <br />the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br />(Section 34- 32- 115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof ofan agreement must be submitted to <br />the Office prior to the decision date.) <br />4. No mining operation will be located on lands where such operations are prohibited by law (Section 34- 32- 115(4)(f), C.R.S. <br />1984, as amended); <br />5. As the applicant/operator, I do not have any mining/prospecting operations in this state of Colorado currently in violation of the <br />provisions of the Mined Land Reclamation Act (Section 34 -32 -120, C.R.S. 1984, as amended) as determined through a Board finding. <br />6. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are <br />punishable as a Class l misdemeanor pursuant to Section 18 -8 -503, C.R.S. 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34- 32- 110,C.R.S., of the Mined Land <br />Reclamation Act Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and <br />subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34 -32 -123, C.R S. <br />Signed and dated this, day of <br />Liberty Mining, LLC. <br />Applicant/Operator <br />1 <br />Title: Managing Partner <br />State of _k <br />ss. <br />County of <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this day of �lJcU4'J�L�i 7 , <br />by <br />� A2 (Q � as � of � <br />OT Y P C <br />JESSE STRIBLEN <br />Notary Public State of Utah My Commission expires: <br />,t My Commission Expires on: SIGNATURES MUST BE IN BLUE INK <br />January 18, 2016 <br />••• Comm. Number: 652031 <br />