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167AWk <br />(10 <br />STATE OF COLORADO <br />COUNTY OF MESA <br />5 rF,uc-rLAAf5 A0U,&Mt, 10 T <br />ss. <br />AFFIDAVIT <br />"A4"ro 9- L/) l? <br />The undersigned, duly sworn, states and affirms that he is the Manager of Flying Triangle <br />Ranch, LLC, the "Prospective Permittee" under permit number M- 2008 -018 and that there are no <br />structures or utilities at or within 200 feet of the permitted premises. <br />Dated this ) 3 day of February, 2014. <br />Cliffo . Henderson <br />SUBSCRIBED AND SWORN to before me this 3 day of February, 2014, by <br />Clifford T. Henderson. <br />WITNESS my hand and official seal. <br />FNOTARY . CARRICO <br />No ry Public <br />RY PUBLIC <br />F COLORADO <br />D #19944017351 My r es pctober 24, 2014 <br />REC,'l- I'VE11 <br />FEB 19 2014 <br />Division of Reclamation <br />Mining & Safety <br />