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-7- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the following <br />terms and conditions: <br />All necessary approvals from local government have been applied for (Rule 1.6.2(1) and (2)); <br />2. This entire mining operation will not extract more than 70,000 tons of mineral, overburden, or combination thereof in any <br />calendar year (defined in Rule 1.1(24)); <br />3. This mining operation will not adversely affect the stability of any significant, valuable and permanent man -made structure(s) <br />located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the applicant/operator and <br />the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br />(Section 34- 32- 115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be submitted to <br />the Office prior to the decision date.) <br />4. No mining operation will be located on lands where such operations are prohibited by law (Section 34- 32- 115(4)(f), C.R.S. <br />1984, as amended); <br />5. As the applicant/operator, l do not have any mining/prospecting operations in this state of Colorado currently in violation of the <br />provisions of the Mined Land Reclamation Act (Section 34 -32 -120, C.R.S. 1984, as amended) as determined through a Board finding. <br />6. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are <br />punishable as a Class I misdemeanor pursuant to Section 18 -8 -503, C.R.S. 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34- 32- 110,C..R.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form and <br />subject the operator to cease �aannd desist orders and civil penalties for operating without a permit pursuant to section 34 -32 -123, C.R.S. <br />Signed and dated this i, day of AIV <br />Mineral Mountain Gold, LLC <br />Applicant/ r <br />Signed: <br />Tide: U �/l% h C 1 Run �Wy <br />'State of <br />County of Qe (� <br />If Corporation Attest (Seal) <br />Signed: <br />A J <br />The foregoing instrument was acknowledged before me t <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />My Commission expires: WV3 <br />SIGNATURES MUST BE IN BLUE INK <br />JAME NELLUM <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID 20154008M <br />I/Y DION EXpIRM FEB 266 2018 <br />