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CERTIFICATION <br /> The Applicant, City of Holyoke (print applicant/company name), <br /> by Orville Tonsing (print representative's name), as Mayor (print <br /> representative's title), does hereby certify that /A/>eA4e/ . A7tl0/ (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for Arthur-Mae Gravel Permit (operation name), <br /> File Number M,?O/f/-D68. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant �j/. e-, 4//itice Representative Name ,� '7WA" <br /> Date 1-9-aol Title /1/l4 i° <br /> STATE OF c ) <br /> ss. <br /> COUNTY OF leu: r ) <br /> The foregoi as acknowledged before me this-I day of , 20 15, by <br /> fll A uQi GIruL( as MIT(� ( o ✓ e( be z . <br /> /Di ( t)1 V t My Commission Expires: (0 " Zia -2018 <br /> Notary Public <br /> TILLIE M FlSBECK <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 19944017529 <br /> MY COMMISSION EXPIRES OCTOBER 2B,2014 <br />