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CERTITIICATION <br /> The Applicant,MIARA MOSS ROCK INC. (print applicawkOnVany nun), <br /> By (trine representative's name). <br /> as Psi at (paint rgxesenfative's tide),does hereby certify <br /> that Kim J.and Kim W.Ban; km9n jstnacMm owner)Shia be compensated for any <br /> damage from the proposed mining operation to the above listed sttuctur e(s)located on or within <br /> 200 feet of the Pmposed affected area demdbed widtin Exh t A,of the Reclamation Permit <br /> Application for COLORADOMOSS ROCK (operatim name). <br /> File Number M 2011-039. <br /> This fora ka been ap mmd by the Colorado Mined land Reclassaffon Boardp► z mrtto its <br /> a dhenty under eke Colorado land Reekwa don Ad forthe Rxbvc ion of ConadacfioaMateriafs <br /> fad Ae Colorado Mraed land Rea oss Ad for HatidRock Mdd,and Denigaa red Musing <br /> Operadma. <br /> Any aherabon or to due form Shoff MR&is this fonu, <br /> ACKNO 1 <br /> Applicant Representative AM <br /> Date Title_ �aG5�06vT <br /> STATE OF COLORADO ) <br /> )ss. <br /> COUNTY OF PUEBLO ) <br /> The faae oing was aclosowledged befm+e me this day ofe_,20 t L by wpmw <br /> of S <br /> My Commission Expires: 2k4adWg A. NpTARy •'y0 <br /> Public ' <br /> . pUB11G :oo <br /> l'AIItY FOR SMUCTURE Q1Vl U may <br /> ACKNO <br /> StructnroOwner Name 01wt SAmiza-krnAm <br /> Date 1. s. Gy �1/ Tide OAPAWre <br /> STATE OF COLORADO ) <br /> ss. <br /> COUNTY OF PUEBLO ) <br /> The foregoing was acknowledged befoee me&kls *day of l�r, ,20 b,1 by <br /> r as QwA*_- of ` <br /> My Commission E*ws_MgcX •.r•i•.. . <br /> otsry Public O.' • ' tt <br /> NOTARY .01. <br />