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W <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 localgovernment 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(4xd), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must he 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, I 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. 1 undcrstand that statements in the application are being mads wider 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 firm and <br />subject the operator to ceas <br />jje and desist orders and ch ilpena/ties for operating without a permit pursuant to section 34-32-123, C.R.S <br />Signed and dated thi`4jlj�� day of 4= <br />Mineral Mountain Gold, LLC <br />Applicant/ or <br />Signed: <br />Title: U wn P�/a �P r0_IY <br />'State of NO1%��. <br />County of e <br />It Corporation Attest (Seal) <br />Signed: <br />J <br />The foregoing instrument was acknowledged before me t <br />by /,A if LI LO �a 1�1�_ as <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />My Commission expires: Ou W� 1 <br />SIGNATURES MUST BE IN BLUE INK <br />NOTARY Pt <br />STATE OF pp-,ORADO <br />+vMARYiD2015400 M <br />MY l�pgpH � � 2018 <br />