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-8- <br />Certification: <br />As an authorized 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 />submittcd to the Office prior to the decision date.) <br />2. 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 />3. 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 <br />finding. <br />4. 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 1 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,C.R.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of thisform shall result in voiding any 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 />GR.S. <br />Signed and dated this F . <br />Rio Grande Silver, Inc. <br />Applicant/Operator Name <br />day of MNY , G. <br />Signature: <br />Title: General Manager <br />in ► <br />�� ) ss. <br />1.,� vu <br />County of utytl+ ) <br />The foregoing instrument was acknowledged before me this <br />If Corporation Attest (Corporate/County Sea]) <br />By'S,4y <br />Corporate Secretary or Equivalent :.��, d : • f 7., <br />Town/City /County Clerk »�,P� • 3 <br />A4q X. Crl� <br />;o tv '�:,� <br />V.;W" <br />by as�Lf �tit�z� 1 rt <br />day of <br />iSi�SSI!]l' R. M(�l ".KOiNSiC! �'ftia deli VI C -Ad&W& <br />Notary Public <br />STAi E n: C -L:C; F:11!)o t 1 % <br />NOTARY ID. X �-.o�!t;,ss My Commission expires: <br />my COt %1"8n :0t: 13,20n <br />