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CERTIFICATION KA ) 0(11 V Z <br /> The Applicant, Carol Ann Pit, LLC, by Robert W. Newby& Carol Ann Newby, does hereby <br /> certify that_Century Link (structure owner) shall be compensated for any damage from the <br /> proposed mining operation to the above listed structure(s) located on or within 200 feet of the <br /> proposed affected area described within Exhibit A, of the Reclamation Permit Application for <br /> Carol Ann Pit, File Number M-I997-02b. <br /> This form has been approved by the Colorado Alined Land Reclamation Board pursuant to its authority under <br /> the Colorado Land Reclamation Act for the Extraction of Construction Afaterials and the Colorado Alined Land <br /> Reclamation Act for Hard Rock, Metal, and Designated Alining Operations Any alteration or modifc o <br /> this form shall result in voiding this form. RECEIVED <br /> NOTARY FOR PERMIT APPLICANT MAR 19 2019 <br /> ACKNOWLEGED BY: DIVISION OFREDtAWTION <br /> MINING MD SAFETY <br /> Applicant Carol Ann Pit,LLC Representative Name <br /> Date ,� Title Maul <br /> STATE OF ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me thid d y o ,20��J,by <br /> �rt Yy A�by as IY�ern her of �Q.�i 8� /`tYt l�l 1'' <br /> My Commission Expires: a1;2-7 : <br /> 4ot�aryy Public <br /> DANETTE M SCHLEGEL <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 2003.1,006913 <br /> My Commission Expires February 27,2019 <br />