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NO �7 (gvc-t K6 MZO B ?®lay <br /> AFFIDAVIT RECEIVED <br /> STATE OF COLORADO ) AUG 0 5 2016 <br /> ss. Division of Reclamation, <br /> COUNTY OF MESA ) Mining&Safety <br /> The undersigned, duly sworn, states and affirms that he is the Manager of Flying Triangle <br /> Ranch, LLC, the"Prospective Permittee" under permit number M-2008-018 and that there are no <br /> structures or utilities at or within 200 feet of the permitted premises. <br /> Dated this 41h day of August, 2016. <br /> Clif d T. Henderson <br /> SUBSCRIBED AND SWORN to before me this 41' day of August, 2016, by Clifford T. <br /> Henderson. <br /> WITNESS my hand and official seal. <br /> E <br /> AN L.CARRICO o ary PublicOTARY PUBLIC <br /> TE OF COLORADO <br /> RY ID#19944017351 <br /> ssion Expires October 24,2018 <br />