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CERTIFICATION <br /> The Applicant, /1rn►.n .P c i rc Vi K 11A . (print applicant/company name), <br /> byJ(01.� yt P 41 <br /> Yl (pri r epresentative's name),as Pre 8-i (print <br /> representative's title),does hereby certify that wept--Pt\e (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 t n'Ir Q 1L Pi -- (operation name), <br /> File Number M-014130- <br /> This <br /> -o A3D-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 r,re%i YLOVMN Representative Name 14, <br /> Date a-oap Title ` Vc-tel r.b.u� <br /> V <br /> STATE OF 1 ��OAv ) <br /> �.,_^rss. <br /> COUNTY OF f rn o ut}�- ) <br /> The foregoing was acknowledge before me thisr9Aay of 202b,by <br /> ��lnn <br /> P. as yr Lfi GL.tl$ of Vt't nv -i440; 2P6614144, ice. <br /> My Commission Expires: /0/c/c:)-9-- <br /> No ' blic <br /> oie <br /> JODI D SCHREIBER <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20064001792 <br /> MY COMMISSION EXPIRES OCTOBER 6,2022 <br />