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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 cinder 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 13FA19' Coutirr Representative Name IJ�� p,iVC <br /> Date 5 0?,3 I to Title C oNE2 •J <br /> STATE OF &(Or0-d O ) <br /> ss. <br /> COUNTY OF ILVL ) <br /> 4� <br /> The foregoing was acknowledged�efore me the day of , 201/, by <br /> c II Loh as o mM t,lL/tO�'1CA of u>\ <br /> My Commission Expires: <br /> Notary Public <br /> SHAREN LYN BRANCH <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10.20004008321 <br /> MY COMMISSION EXPIRES MAY 22,2017 <br />