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-8 - <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />1. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made structures) <br />located within two hundred (200) feet of the affected lands. (However, where there is an agreement between the app)icantloperator <br />and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicantloperator <br />(Section 834-32-115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of an agreement must be <br />submitted to the Office prior to the decision date.) <br />2. No mining operation will be located on lands where such operations are prohibited by law (Section 3432-115(4)(f), C.R.S. <br />1984, as amended); <br />3. As the applicant/operator, I do not have any mining1prospecting operations in this state of Colorado currently in violation ofthe <br />provisions of the Mined Land Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a Board <br />finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are <br />punishable as a Class 1 misdemeanor pursuant to Section 18-8-503, C.R.S. 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-112,CR.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form <br />and subject the operator to cease and desist orders and civilpenalties far operating without a permit, pursuant to section 34-32-123, <br />C R. S. <br />�A t�"7 <br />Signed and =teTs �' dayof �""tCripple Cictor GoldlMining Company <br />JAl perator NSignatuTitle: ral M nager <br />State of C&c)\rCxJ-C) <br />) <br />{ <br />)Ss. <br />County of 1 �.� 1e_ ) <br />The foregoing instrument was acknowledged before me this <br />If Corporation Attest (Corporate/County Seal) <br />By: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />day of <br />of � ► Y -pe -LC ' V ��Crr,,�r' <br />'•`.�` NW4;Z77 <br />: tB Nota ublic <br />i P My Commission expires: 10 C�� 1 �� <br />PUBLIC [� <br />k'h►�.......... wtlr <br />