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3/31/2020 Screen sh ot20200325-11 2220—CamScan ner.j pg <br /> CE R T I FI G;NTI 0 N <br /> The Applicant, North Star Turquoise, LLB (print applic�m('conili�tnv name). <br /> 4 <br /> b Wr /'L t- ;4.m-1�--��(Print <br /> y- _(print representative's narne),as/�"_f <br /> t -f I I <br /> representative's title),d c <br /> floes hereby certify that 'V.'L c v.1V 01 t(t__(structure owner)SlIall <br /> be compensated for any damage from the proposed mining operation to Ilic above listed structure(s) <br /> located on or within 200 feet of the proposed affected areadcscrJ,,ed w'01;11 E%JA)'J .A of 1 lie Reclani atioll <br /> Permit Application for Bad Boys Pit <br /> File Number M-1996-281 <br /> TItisform has been approved by the Colorado Mined LandReclaination Boardpitrsrtant to its <br /> authority under the Colorado Land Reclamation Act or the Extraction ofConstruction-.11aterials and <br /> the Colorado Alined Land Reclantation Act for Hard Rock,Metal,and Designated 111ning Operations. <br /> Any alteration or modification to t1tisforno shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGM BY: el�� <br /> Applicanttlo.,,-� Cyr Representative Naive L_ze< <br /> Date -3/,///-2 0 Title X.4f4 e'rr'C '' - <br /> STATE OF <br /> )SS. <br /> / <br /> COUNTY OF e-' 1f�,r' -) <br /> foregoing was acknowledged before me this/� day of 20,)Pby <br /> as 1"'rZnn��i Of 1116Y-4t, <br /> My Commission Expires: <br /> Notary Public <br /> 'WELTS FARGO BANK,NA. OEME GRN" <br /> WOODLAND PARK PLA7A OFFICE NOT*y PUBLIC <br /> 1101 E HWY 24 STATE OF COLOR" <br /> WTM to 19MOIS675 <br /> WrxAmd NA.00 8W3 W COMMSSMDN[wows OUOMR 27.20, <br /> https://mai1.google.com/mai1/u/O/#inbox/WhctKJVqstCWdNTLrTtGMRwSdNMHrJGPLgdMbsLgTnwqIVBZnNjIPxPVrCCMLckBrRxgZRL?projector=1&messagePartId=0.1 1/2 <br />