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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 /> I. 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(Sedation 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 trade <br /> herein are punishable as a Class I misdemeanor pursuant to Section 18-8-503,C.R.S 1984,as amended. <br /> This form has been approved by the r'i9'ined Lane!Reclamation Board pursuant to section 34-32-114C.R.SS,of the Mined Lanni <br /> Reclamation Act Any alteration or modfflication of this form shall result in voiding any permit issued on the altered or rnoetkd <br /> form and sub)ect the operator to erase and desist orders and civil penaldess for operating without a permit pursuant to <br /> section 34-32-123,C.R.S. <br /> + <br /> Signed and dated this f" day of C;V e 'V V"� " � t <br /> Titan Au, Inc. If Corporation Attest(Seal) <br /> Applicant/Operator or Company Name <br /> } r <br /> Signed., --'" .. Signed: <br /> Corporate Secretary or Equivalent <br /> Town/City/County Clerk <br /> f <br /> Title: <br /> State of �_'b LtOZJQ 0 ) <br /> )ss. <br /> County of WE7-D 1 <br /> The foregoing instrument was acknowledged before me this � day of C <br /> , M. <br /> by t'j 1�V 1"�ILl.�/-.- as,.A4_—Ml igg-J, of IZ-1-4J0 ALA't tAll _. <br /> -�""-' Na bile <br /> ELIZABETH T. DlVITTORIO <br /> NOTARY PUBLIC My Commission expires; � <br /> STATE OF COLORAOO SIGN URES MUST BE IN BLUE INK <br /> NOTARY !D 20I240�056$MY COMMISSION EXPIRES MARCH 30, 2020 <br />