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i <br /> CERTIFICATION <br /> The Applicant, Tzcc {�� C (print applicant/company name), <br /> by N1cap S tMPs� (print representative's name),as (pit <br /> representative's title),does hereby certify that Ztv"1cc Ban 2«,k, UC - (siructme owner)sball <br /> be compensated for any damage from the proposed mining operation to the above listed st maure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A,of the Reclamation <br /> Permit Application for VQXRns y, Mos's X,"e (operation name), <br /> File Number M-2&1t-OM. <br /> This form has been approved by the Colorado Mined Land,Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Ad for the Extraction of Construction Materials and <br /> the Colorado Muted Land Reclamation Ad for Hard Rocky Meta4 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 'P ►�tco�h' LLG Representative Name f Lac S�M ►� <br /> Date_ j 21i,b 9 Title <br /> STATE OF M t� _) 19 <br /> � JENNY CHRISIINE HETLAND <br /> NOTARY PUBLIC•MINNESOTA <br /> COUNTY OF n- � ) <br /> MY COMMISSION EXPIRES 01/31/20 <br /> The foregoing was aclmowledged before me this day of ,20 I,by <br /> D i as of Ucl <br /> y Commission Expires: <br /> o Pub <br />