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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 Dolores L French own the following structure(s), located within 200 feet of the <br /> permitted mining area: Wire fence along county road. <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 Dolores L French 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-303-286-2247 <br /> Signature ��� Date,J7-11 r/Ir Cynthia Antrim <br /> STATE OF Colorado ) Notary Republic, State of Colorado <br /> ss My Commission Expires February 19,2020 <br /> COUNTY OF Adams ) Notary ID:20084005737 <br /> The foregoing was acknowledged before me this day of ( --&i _ 12016, <br /> by Lynn M. Shults as Regulatory Manager of L.G. Everist, Inc. <br /> a <br /> Notary Public-, .li�-mot My Commission Expires <br /> . <br /> NOTARY FOR STRUCTURE OWNER <br /> ACKNOV&EDGED BY. <br /> Structure Owner(s): 'D-plefes L French Contact name (print): <br /> Signature: �14'4ate: <br /> STATE OF i'r/I <br /> )ss ISAAC J.MORA <br /> COUNTY OF UCL-F ) NOTARY PUBLIC <br /> STATE OF COLORADO <br /> The foregoing was acknowledged before me this day of 201(310_�ARY ID 20124080526 <br /> MY COMMISSION EXPIRES 1211111011 <br /> Notary Public: _My Commission Expires. l2 i - <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL # 7014 2870 0001 0807 9844 <br />