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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 <br /> structure(s)located within two hundred(200)feet of the affected lands. (However,where there is an agreement between the <br /> applicant/operator and the persons having an interest in the structure that damage to the structure is to be compensated for by <br /> the applicant/operator(Section 34-32-115(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of <br /> an agreement must be 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 34-32-115(4)(f), <br /> C.R.S. 1984,as amended); <br /> 3. As the applicant/operator,I do not have any mining/prospecting operations in this state of Colorado currently in <br /> violation of the provisions of the Mined Land Reclamation Act(Section 34-32-120,C.R.S. 1984,as amended)as determined <br /> through a Board finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br /> herein are 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,C.R.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 <br /> form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to <br /> section 34-32-123,C.R.S. (/ <br /> Signed and dated this r�L day of f v , <br /> Titan Au, Inc. <br /> If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> Signed (� �— Signed: <br /> Corporate Secretary or Equivalent <br /> Jee ,e7-1-14R Town/City/County Clerk <br /> Title: K <br /> State of (O L O4i4))O ) <br /> ss. <br /> County of WELD l <br /> The foregoing instrument was acknowledged before me this 7 day of J N6'( E (-4904S: <br /> by f l I ASD V H/tu 7Z as j* lee-r402_)) of 77 r,qA> i v1 /NC> <br /> 44771/7?I: <br /> ELIZABETH T. DIVITTORIO Nota., Public <br /> STAN 4?DA� <br /> MARCH 3 <br /> STATEOTOF <br /> Y COLORPUBLADO SIGN My Commission expires: <br /> NOTARY ID 20128 <br /> MY COMMISSION EXPIRES MARCH 30, 2020 URES MUST BE IN BLUE INK <br />