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CERTIFICATION <br /> The Applicant, Martinez Western Constructors inc. (print applicant/company name), <br /> by Paul Martinez (print representative's name), as Vice President (print <br /> representative's title), does hereby certify that mary ann sink, and mary ann sink trust(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 Ducray Pit 2 (operation name). <br /> File Number M-2019-035 . <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 fur Hard Rock, Metal, and Designated]Dining Operations. <br /> Any alteration or modification to this form shall result in voiding this firm. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: ffrf <br /> A licant ri�(: "" (bt.€ ; �` ° if �' ��. 1� Representative Name <br /> PP , <br /> Date = ' Title <br /> r <br /> STATE OF <br /> ss. <br /> COUNTY OF <br /> The foregoing was acknowledged before me this? day of €y 20 by <br /> 1G4f � �i Iri � as �t lr �Ir" t �ir � `r rig ri <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 19,2020 <br />