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RPM,Inc. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials <br /> and the Colorado Mined Land Reclamation Act,for Hard Rock,Metal,and Designated Mining <br /> Operations. Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Applicant:Venture Resources,Inc. <br /> Representative Name:Patrick Maher <br /> Date: �z h• Q 9 Title:President <br /> STATE OF COLORADO <br /> COUNTY OF GILPIN <br /> The foregoing was acknowledged before me this day ot�2019, <br /> by/ `)x as iC of ft )Pa r 0-t'ee,4 <br /> My Commission Expires: <br /> otary lic <br /> 7RACY M.OPEL. ." <br /> NOTARY STRUCTURE OWNER ;t. NOTARY PUBM <br /> OF COLORACK: <br /> =KTARY tD 2017403 45' <br /> ACKNOWLEDGED BY: 30MMMcM E GnRES 7.26. <br /> Strueture Owner:Old Town Mine,LLC <br /> Representative Name:Patrick Maher <br /> Date: _� �` ��/ 9 _ Title:Managing Member <br /> STATE OF COLORADO <br /> COUNTY OF GILPIN <br /> The foregoing was acknowledged before me this c�-)/ day of ar Ol 9, <br /> by-����T—�as��� of—�J /fir LL <br /> My Commission Expires: <br /> otary P is <br /> ,,,,RMY M.OPEL -.. . . <br /> NOT&RY PUBLIC <br /> STATE OF COLORAD�: <br /> W-TARS'iC 2017403144 <br /> 12 <br />