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44 <br /> CERTIFICATION <br /> The Applicant, Cheyenne County (print applicant/company name), <br /> by Marcy Brossman (print representative's name), as County Administrator (print <br /> representative's title), does hereby certify that Harold Rother Farms, Inc. (structure owner) shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br /> Permit Application for Rother Pit#2 (operation name), <br /> File Number M-2019- 036 . <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 and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant Cheyenne County Representative Name Ma#yBrossm"anl' <br /> Date July 17,2019 Title County Administrator <br /> STATE OF Colorado ) <br /> ) ss. <br /> COUNTY OF Cheyenne ) <br /> The forego*Vt)S5W\0A <br /> was acknowledged before me is day of�LJ , 20�, y <br /> e as CN%IA, of <br /> My Commission Expires: r7V� <br /> Notary Public <br /> pATRICIA A DAll01IERTY <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY 10 201540007448 <br /> MY COMMISSION EXPIRES FEB 20,2023 <br />