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CERTIFICATION <br />The Applicant, Las Animas County <br />applicant/company name), <br />by Gary D. Hill (print representative's name), as Chairman Board of Commissioners (print <br />representative's title), does hereby certify that Doherty Y Tfs /d e -11 C, ('s' tru° ct jur re <br />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 Branson Gravel Pit <br />File Number M -1997 -100 <br />(operation name), <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 />ACKNOWLE ED BY: <br />Applicant <br />Date <br />STATE OF QOI(1` CL--LO ) <br />) ss. <br />COUNTY OF LAS 14"(gA -, ) <br />The foregoing was acknowledged before me this 3rf' day of r0a v-di , 2015, by <br />- a r,,j D. N; I as � Wjj i vviri in of BorgV-d p-Ci Co vv�rrnrss��r�� <br />Notiry Public <br />My Commission Expires: c)(0 10,3 '�o 18 <br />KIMBERLY A. CHAVEZ <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 19984014199 <br />COMMISSION EXPIRES JUNE <br />