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CERTIFICATION <br /> The Applicant, Martinez Western Constructors Inc. <br /> By Paul Martinez <br /> As Vice President, does hereby certify that Mary Sink Trust, (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the <br /> Reclamation <br /> Permit Application for Ducray Pit <br /> (operation name), <br /> File Number M-2018-018. <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 <br /> Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining <br /> Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWL <br /> A plicant i!' Representative Name <br /> i <br /> Date Title <br /> STATE OF < ) <br /> ) ss. <br /> COUNTY OF <br /> The foregoing was,acknowledged before re this day of r , 20 , by <br /> now 4 i as O 1 ✓ of <br /> My Commission Expires: <br /> Notary Public <br /> ANNE DUSTIN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20044009724 <br /> My Commission Expires March 18,2020 <br />