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The Applicant, <br />CERTIFICATION <br />SPRAGUE STONE LLC <br />by MATTHEW SPRAGUE <br />(print applicant /company name), <br />representative's name), as VICE PRESIDENT <br />(print <br />representative's title), does hereby certify that NIA (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 SPRAGUE STONE (operation name), <br />File Number M- - <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 MIQC-41 Representative Name/ <br />Date Rb j`Z - ?0 15 Title V , CF <br />STATE OF Oo/oraalo ) <br />/ ss. <br />COUNTY OF <br />The foregoing was acknowledged before p�e this �-Z day of ) ebraar , 20 /3, by <br />�>4eOJ. �r�as l ee t'i'es�ale,7 of i <br />My Commission Expires:���i�z0 /S <br />Notary Pu c <br />MINDY G ZSCHEILE <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID # 20074029596 <br />MY COMMISSION EXPIRES AUGUST 02, 2015 <br />