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CERTIFICATION <br />The Permit Applicant and Mine Operator, Vesco Consulting Services, LLC by <br />1111 h-Atl, M IU "- , as I)Ztll ilK ' (Title) does hereby certify that <br />5i/IZZ IfAtXA OFIAN) COMM ISh&&f (structure owner) shall be compensated for any <br />damage from the proposed mining operation to the above listed structure(s) located on or within 200 <br />feet of the proposed affected area described within the letter attached to this agreement, of the <br />Reclamation Permit for GoodMiller #2 Pit, Permit File Number M- 2014 -070. <br />This form has been aAm med by the Colorado Mined Land Reclamation Board pursuant to its authority under the <br />Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined Land <br />Reclamation Act for Hard Rock Metal, and Designated Mining Operations. Any alteration or modification to this <br />form shall result in voiding this form. <br />NOTARY FOR PERMIT APPL)�CANT <br />ACKNOWLEGED BY: <br />Applicant V (:&C O Representative Name /K t,�.l•�iJL <br />Date Title �LtJZ(�i1(C_ <br />STATE OF taun dN ) <br />COUNTY OF . ) <br />The foregoing was acknowledged before me this day of h , 20�, by <br />of <br />My Commission Expires:. <br />Notary Public <br />E A BRISBY <br />RY PUBLIC <br />F COLORADO <br />0 # 19984004229 XPIRES JANUARY 08.2019 <br />