2015-02-27_GENERAL DOCUMENTS - M2014070

• Permit No: M2014070
• IBM Index Class Name: GENERAL DOCUMENTS
• Doc Date: 2/27/2015
• Doc Name: Damage Waiver For Exhibit S
• From: GoodMiller #2 Pit
• To: DRMS
• Section_Exhibit Name: Exhibit S
• Email Name: ECS
• Media Type: D
• Archive: No

NOTARY FOR STRUCTURE OWNER WITHIN 200 FT OF REVENUE MINE AFFECTED
AREA
ACKNOWLEGED BY:
Structure Owner Name
Date Title
STATE OF Co[o rJ-b
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COUNTYOF tAor�5gr\—)
The foregoing was acknowledged before me thisW day of 20 15, by
Cq ye" as SAt el— —of
My Commission Expires:
Notary Public
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