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CERTIFICATION <br /> The Applicant,Collins-Morehead LLC (print applicant/company name), <br /> by Daniel L. Collins (print representative's name), as Manager (print <br /> representative's title), does hereby certify that Collins Morehead LLC (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 Limited Liability Partnership (operation name), <br /> File Number M- 1986 102 <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 Collins-Morehead LLC Representative Name Daniel L. Collins <br /> Date V/92'7/20/di Title Managing Partner <br /> STATE OF iffi P3174 ) <br /> )ss. <br /> COUNTY OF �t�Z> j <br /> The foregoing was acknowledged before me this 27day of itpY1 I , 20 ko by <br /> Co7-1.44 f as ___At t,2tt9 J/k2li of <br /> A e �►II n ( My Commission Expires: D / /Y <br /> LYMAE eERitYwcl <br /> z. commission,3301129 <br /> Hoary Public-Anions <br /> Sly Commission expires <br /> Flamm 14,MS <br />