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S19 <br /> CERTIFICATION <br /> The Applicant,Turkey Canon Quarry Inc., byM A Z V Ntio,-�, as V, `does hereby certify <br /> that JERRY OR NANCY NELSON (structure owners)shall be compensated <br /> for any damage from the proposed mining operation to the above listed structure(s)located within 200 feet of the <br /> proposed affected area described within Exhibit A,of the Reclamation Permit for Vollmer Pit, <br /> File Number M-1983-035. <br /> Signature ofApplican <br /> t <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority <br /> under the Colorado Land Reclamation Act for•the Extraction of Construction Materials and the Colorado Mined <br /> Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations.Aap alteration or modification to <br /> this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: JI&W3 Ott W lflb Representative Name: K <br /> (Please prints) (Please print) <br /> Date: 0�`abL��- `1 Za` Title: 0 <br /> STATE OF COLORADO ) <br /> ) ss. <br /> COUNTY OF El PASO ) <br /> The foregoing was acknowledged before me this" day of DylV6 , 2018, by <br /> G09JDO ( kMA-� <br /> (si ture of owner or representative) (title) (company name) <br /> 5 My Commission Expires: VvjAA 3a <br /> Notary Public Signature <br /> ERIC S HOWARD <br /> Notary Public <br /> State of Colorado <br /> Notary 1D M 20144021884 <br /> My Commission Expires 05-30.2022 <br /> Page 2 of 3 <br />