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PERMITTEE/STRUCTURE OWNER AGREEMENT <br /> State of Colorado, Mined Land Reclamation (MLR) law requires the permit applicant(operator/permittee) <br /> to agree to reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted <br /> mining area for damage done to the structure(s) as a result of the permitted operation. <br /> L.G. Everist, Inc. believes Pasquale Varra own the following structure(s), located within 200 feet of the <br /> permitted mining area: wire & pipe fences, corrals, Barn & House. <br /> L G. Everist, Inc. agrees to reimburse you for any damage done to the listed structures as a result of the <br /> mining operation Your acknowledging signature and a notary seal in the spaces provided below shall <br /> satisfy the MLR law requirement. L.G. Everist, Inc. certifies this agreement as follows <br /> CERTIFICATION: The Applicant, L.G. Everist, Inc., represented by Lynn M. Shults, as Regulatory <br /> Manager, does hereby certify that Pasquale Varra shall be compensated for any damage from the <br /> proposed mining operation to the above listed structure(s) located within 200 feet of the permitted mining <br /> area described in the MLR Permit for Carbon Valley Resource (M-2001-017). <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: L.G. Everist Inc 7321 E 88th Avenue Suite 200 Henderson CO 80640 <br /> Representative. L nn M. Shults Regulatory Manager, office -303-2 <br /> Signature '� � Date: 1 f Cynthia Antrim <br /> Notary Republic, State of Colorado <br /> STATE OF Colorado ) My Commission Expires February 19,2020 <br /> ) ss Notary ID:20084005737 <br /> COUNTY OF Adams ) <br /> The foregoing was acknowledged before me this day of �=� 12016, <br /> by Lynn M. Shults as Regulatory Manager of L.G. Everist, Inc. — <br /> �f If <br /> Notary Public;�, rll r -C.��.- "�2��u-ate My Commission Expires: <br /> I <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOWLEDGED BY: <br /> Structure Owner(s): Pasquale Varra Contact name (print): <br /> Signature: Date: 'i1�zk <br /> STATE OF F QrC ) ss JESSICA HOOVER <br /> NOTARY PUBLIC <br /> COUNTY OF ���G STATE OF COLORADO <br /> NOTARY ID 20044035571 <br /> My Commission Expires Oct. 4, 201E <br /> The foregoing was acknowledged before me this day of 201 y <br /> POI 5ct,�AatQ Vo- rr'5"' <br /> Notary Public: .-� My Commission Expires: ) .014b <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL 4 7014 2870 0001 0807 9820 <br />