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-8- <br /> Certification: <br /> As an authorized representative of the applicant,I hereby certify that the operation described has met the minimum requirements of the <br /> following terms and conditions: <br /> 1. This mining operation will not adversely affect the stability of any significant,valuable and permanent man-made structure(s) <br /> located within two hundred(200)feet of the affected lands. (However,where there is an agreement between the applicant/operator <br /> and the persons having an interest in the structure that damage to the structure is to be compensated for by the applicant/operator <br /> (Section 834-32-115(4)(d),C.R.S. 1984,as amended),then mining may occur within 200 feet. Proof of an agreement must be <br /> submitted to the Office prior to the decision date.) <br /> 2.No mining operation will be located on lands where such operations are prohibited by law(Section 34-32-115(4)(f),C.R.S. <br /> 1984,as amended); <br /> 3. As the applicant/operator,I do not have any mining/prospecting operations in this state of Colorado currently in violation of the <br /> provisions of the Mined Land Reclamation Act(Section 34-32-120,C.R.S. 1984,as amended)as determined through a Board <br /> finding. <br /> 4. I understand that statements in the application are being made under penalty of perjury and that false statements made herein are <br /> punishable as a Class 1 misdemeanor pursuant to Section 18-8-503,C.R.S. 1984,as amended. <br /> This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-112,C.R.S., of the Mined Land <br /> Reclamation AcG Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified form <br /> and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to section 34-32-123, <br /> C.R.S. <br /> Signed and dated this 31 day of Det - ,11 NO CORPORATE SEAL <br /> Cripple Creek&Victor Gold Mining Company If Corporation Attest(Corporate/County Seal) <br /> Applicant/Operator Name <br /> Signature: 7� By: <br /> General Manager Corporate Secretary or Equivalent <br /> Title: Town/City/County Clerk <br /> State of Co/o a- -t7 ) <br /> )ss. <br /> County of re-lie-r— ) <br /> The foregoing instrument was acknowledged before me this Vi day of 4 L , o) 0/9 <br /> by/Il%ke S f er-,'1 &r1/9,k rcuE <br /> 4- vica"n 60/40 114%/71.12, CO <br /> _.:-. _.-.�.:- ,• ..-.: <br /> & di,' <br /> NORMA M.TOWNLEY ti Notary Public <br /> NOTARY PUBLIC t 1 <br /> ti <br /> STATE OF COLORADO M Commission expires: I �/ - 01 <br /> NOTARY ID 19934016402 ti y p <br /> , MY COMMISSION EXPIRES DECEMBER 21,2021 <br />