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The Applicant, <br />CERTIFICATION <br />SPRAGUE STONE LLC <br />(print applicant/ company name), <br />by MATTHEW SPRAGUE (print representative's name), as VICE PRESIDENT <br />representative's title), does hereby certify that N/A <br />structure 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 SPRAGUE STONE <br />File Number M - <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 />ACKNOWLEGED BY: <br />Applicant l 5 -,� �� `� Representative Name <br />r, <br />Date fq b 1 `� - �� Title <br />STATE OF <br />// ) ss. <br />COUNTY OF Zewl i/�e,�r ) <br />The foregoing was acknowledged before�e this / Z day of fb�uQi�1 , 20 i� , by <br />as ✓��C JL <br />of <br />ofiac�ir'� <br />J - <br />�j <br />My Commission Expires: <br />Notary Publfc <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID:: 20074029596 <br />_MY COMMISSION EXPIRES AUGUST 02. 2015 � <br />