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-8- <br />Certification: <br />As en authorized mpresentaUve of the appUmt, I hereby caufy that the operation desmbed hugs mua.the rutiirwaoamnrcqwnmcms of <br />the following term and conditions: <br />1. To the best ofuty knowledge, all significant, valuable and pernum tman made strucone(s) inexistence at the time this <br />application is filed, and located within 200 feet of the proposed affected area have been identified in this application <br />(Section 34 32.5- 115(4Xe), C.R.S.). <br />2. No mining operation will be located on lands where such operations an prohibited by law <br />(Section 34. 325- 115(4ft C.R.S.; <br />3. As the applicandoperator, I do not have any extractioWexploration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Lana Reclamation Act for die Extraction of Construction Materials <br />(Section 34 -32.5 -120, C.R.S.) as deteamined through a Board finding. <br />4. I uurderstanddud statements in the application are being made under penalty ofpcgwy and that false stateumm made <br />herein are punishable as a Class 1 mar pursuant to Section 18- 8-503, C.R.S. <br />Tbk form has been opprewad by Ae Mbred Laird Redradan Board rwmant to section 34JZS -112,( <br />Redamm ion AdforAbe Rxbaedm efCoitsirutgon Mates7Pals. Any akoadon or mog@kmdm of&kfm <br />per akksaedan tieaUered armoetj&dform and subject the opffator to cmreaaddedeterdrra and "p <br />apermitpW=ra+uttomedmi; 332."23, CR.9 a <br />Signed and dated this day of Zo�S <br />I1! <br />Z OWar. <br />or Co nvarw Name <br />rr 7 <br />State of C mto a b <br />Cowuty of W" <br />YCmporatiw Attest <br />Land <br />` ~� 1`��. <br />Jam• <br />Y <br />/ <br />Jn <br />r V <br />Caporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this �,L S day of "rt k _ A. / <br />,Q, n�1 i� j�•';eeL N Public <br />id VankBaatvaoemtc�muuoo112mc tnpp+ovedosn: <br />My commission aspires: LVA,44=9 <br />UE INK <br />