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CERTIFICATION <br /> The Applicant, Martinez Western Constructors Inc. <br /> By Paul Martinez <br /> As Vice President, does herebv certifv that Mary Sink Trust, (structure oxyner) 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 Ducra} <br /> (operation name), <br /> File Number M-2018-018. <br /> This form hits been approved by the Colorado Mined Lard Reclamation Board pursuant to its <br /> authorio, under the Colorado Lard Reclamation Act for the Extraction of Construction <br /> Materials and <br /> fire 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 /> 1pph,ant Representative Name <br /> Z - � � <br /> Date f 2�1�2 Title <br /> STATE OF y:. . ►,cc1 <br /> ) ss. <br /> COUNTY OF I^r c ) <br /> The foregoing was,acknowledued before a thisL�day of _ i , ;< . 20; �L- by 11 <br /> f( _its Cr,, ,.4 of ;rl 1►" �, i'" <br /> My Commission Expires: -� _ <br /> Notary Public <br /> ANNE DUSTIN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> (VOTARY ID #20044009724 <br /> My Comrnission Expires March 18,2020 <br /> Attachment A(Page 4 of 6); Ducray Pit#2; Permit#M-2019-035; Operator/Applicant: Martinez Western Constructors <br /> Page 8 of 21 from Mary Ann Sink Trust <br />