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CERTIFiCAi <br />TlreApplicant, i.QLi . K 84r LQr A (J., -C�,+ �,I & CO pti t appliewVompany name), <br />by eL cu.! `cS LA4 -c (prnat reprc=tstiws name), as Manager' (pr nt <br />represe vc's tide) does hereby certify that )4gq, a2 �y� (` r jr- e f t e ( uchze owner) shalt <br />be compensated for any damage from the Proposed mining operation to the above listed re(s) <br />located on or within 200 feet of fine proposed at%d area described within Exhibit A, of the RecWnation <br />Pamit Application for UncaMPah9re Pit (operation name), <br />File Number M-2013- -007 <br />This form hies been appnvved by tike Cob aado Mred Land Redamaden Board pw= wit to fts <br />aawr"My WNW dw Cokrardo n ahm Act fakir the Esanacdan of CorzWucdm Mawiafir and <br />dw Colorado Mfrrad LardRedar WkwAet forffaRrdRorhy MeW and DssiVvared h M-ft 4"Mionx <br />Airy abe>a don or nmdiJiealm to this form sW muft in wh tirgMhfarrc <br />NOTARY FOR PERMff APPLICA <br />ACRNOWLEGED BY: <br />ApplicantLa1 L fA LA&^� eeyig- Co Me Represefftative Name �_�y I&-,, <br />Date ��c�ie. J a Title Cy- Ae-r,Lt <br />STATE OF CO LORAcDO ) <br />COUNTY OF WN JWtf • <br />The fompmg was acknowledged before me this 12- day of KDRVLA91 , 20 5 by <br />3 y_.VA.TT. .±� as C�%r.N� / N .of_LA;P,,4 J�. 842 IAVJ©� ATTLE, 60 11 tP <br />Expizos- I /g7 WI to <br />