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CERTIFICATION <br /> The Applicant, Bent County (print applicant/company name), <br /> by Bill Long (print representative's name), as Commissioner (print <br /> representative's title), does hereby certify that Bob & Ronda Bucholz (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 Thomeczek Pit _ (operation name), <br /> File Number M-1995-007 . <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority tinder the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act far Hard Rock,Metal, and Designated Mitring 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 $,--ay r C c N Representative Name <br /> Date � _._ Title Cc,"msfr.CcNER -- <br /> STATE OF- a v7 d Q . ) <br /> ) ss. <br /> COUNTY OF I11 � ) <br /> The foregoing was acknowledged before me this��a y of I ' , 20_L�?, by <br /> as of <br /> n ()Vwk S) _ My Commission Expires: A�0, A Q <br /> Notary Public <br /> SHAREN LYN BRANCH <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10 S 20004006321 <br /> MY COMMISSION EXPIRES AIRY 2 t� <br />