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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 7/92% Title Managing Partner <br /> STATE OF fir/ 27-304 ) <br /> )ss. <br /> COUNTY OF Gt/( ) <br /> The foregoing was acknowledged before me this 27day of '21 I ,20 k by <br /> C ou.-t n(f as F'4rl-f1/44 �t,•tj, P/k&m4Flc of i 1 Z nt s.— i Lc f f t7 t_c.C' <br /> / <br /> IPi i � t My Commission Expires: U / o2D <br /> 1 ` : ' ?lc LYNAE eE1 RYHILL <br /> �.' con.ai..w�+•s� <br /> �► Motrlr Annie-Aroma <br /> .111, listitops County <br /> My <br /> Fellows,/14 MS <br />