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-8- <br />Certification: <br />As an authorised representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />1. 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 <br />and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant /operator <br />(Section 834-32-115(4)(d). C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be <br />submitted to the Office prior to the decision date.) <br />2. No mining operation ,trill 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 />3. As the applicanuoperator, 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 <br />finding. <br />4, 1 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 I 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- 112,CR.S., of the Mined Land <br />Reclamation Act Any alteration or modification of this form shall result in voiding an v permit issued on the altered or modified form <br />and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34 -32 -123, <br />C. R.S. <br />Signed and dated this I t! day of <br />Cripple Creek & Victor Gold Mining Company (CC &V) IfCornoration Attest (C'ornorate /County seals <br />Applicant /Operator Name <br />Signature: <br />U <br />LOW <br />Q <br />Corporate Secretary or Equivalent <br />Title: Vice President of Anglogold Ashanti (Colorado) Corp. & T'own'City /County Clerk <br />General Manager of Cripple Creek & Victor Gold Mining Company <br />State of <br />County of ! v,— L ts2P_ ) <br />The foregoing instrument was acknowledged before me this <br />day of <br />J <br />by — t- �'� '� as of }Yk4 < tf *tt✓ �¢�1 * 1 /rt!tf*22rrw Cz��jrxs�y <br />Il,rL"itcl <br />A. y 1 <br />tary Public <br />..�.� O My Commission expires: %f f U .5� U/ <br />0 F tr O'1 <br />