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CERTIFICATION <br />The Applicant, Rancho Greco Partnership (print applicant/company name), by <br />John Raftopoulos (print representative's name), as Member/Owner (print <br />representative's title), does hereby certify that John Raftopoulos (structure owner) <br />shall be compensated for any damage from the proposed mining operation to the above listed <br />structure(s) located on or within 200 feet of the proposed affected area described within Exhibit <br />A, of the Reclamation Permit Application for Rancho Greco Partnership (operation <br />name), File Number M- 2015 - 027 . <br />This form has been approved by the Colorado Mined Land Reclamation Board <br />pursuant to its authority under the Colorado Land Reclamation Act for the Extraction of <br />Construction Materials and the Colorado Mined Land Reclamation Act for Hard Rock, Metal, <br />and Designated Mining Operations. Any alteration or modification to this form shall result in <br />voiding this form. <br />ACKNO <br />Applican <br />Date <br />NOTARY FOR PERMIT APPLICANT <br />STATE <br />OF COLORADO <br />) ss. <br />COUNTY OF MOFFAT <br />Representative Name d p tFN Td I°o1(J DS <br />Title <br />The foregoing was acknowledged before me this < I ' day of Ni 0 Jr44 31 - , 20 6 , by <br />ti -0 ik-FrOprx.«r) as MEM -600 Oi,1K; of A-NCAC) � Qf LLP <br />My Commission Expires: <br />BRANDY HIXSON <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID #20144036297 <br />My Commission Expires September 18, 2018 <br />