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1/17/2020 structure2.jpg <br /> CERTIFICATION <br /> The Applicant, LING (print applicant/company name), <br /> by 14 5Mr rOS?,b (print representative's name),as C F O (print <br /> representative's title),does hereby certify thatT►�t!iw#.vows trclwc+t RR..)cw(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 G-A%0 M1t4"E (operation name), <br /> File Number M-1Vtj-3% . <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 SF4 LL.G Representative Name_79-1 wwfA StPFFo <br /> Date Title P r <br /> STATE OF ) <br /> )ss. , <br /> COUNTY OF ) <br /> The foregoing was acknowledged before me this .20 day of 20_,by <br /> as C 60 LLB <br /> G� 4,dL, My Commission Expires:Q� 02.3— oZDa 3 <br /> Notary Public <br /> SHAWN LOUISE WISE <br /> Notary Public <br /> State of Colorado <br /> Notary ID#201 5401 821 7 <br /> My Commission Expires 09-23-2023 <br /> https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgxwGCtDLKZXgCTcpFsGmhVlTzLKg?projector=l&messagePartld=0.3 1/1 <br />