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CERTIFICATION <br /> The Applicant, Gregg Morrill, as Owner. does hereb- ccrtih that Montrose County Road and <br /> Bridge (structure owner) shall be compensated for am damage from the proposed mining <br /> operation to the above listed structure(s) located on or within 200 feet of the proposed affected <br /> area described within Exhibit A. of the Reclamation Permit Application for the Bancroft Placer <br /> Mine, File Number M-2020-025. <br /> This farm has been approved bi•the Colorado Mined Land Reclamation Board pursuant to its authori{t�under the <br /> Colorado Land Reclamation Act liar the Extraction of Construction Materials and the Colorado Mined Land <br /> Reclamation Act for Hard Rock. Metal, and Designated Alining Operations. .4nv alteration or modification to this <br /> form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant .�-�• _ Representative Name <br /> � Z.,► ° <br /> Date 2-3 `Z 42 d Title <br /> STATE OF <br /> l )COUNTY OF �C� T`� ss. <br /> The foregoing was acknowledged before: me this day oi',--_ . 20. <br /> bN <br /> MLTC.► , as-� _ _ of <�(lLj <br /> My Commission Expires:___ '� <br /> Notary Public <br /> ERIN STAATS <br /> NOTARY PUBLIC <br /> STATE OF COLp{ZAD(, <br /> NOTARY ID#20194032M3 <br /> My Comnxt+t+on EVM A"QW 21,� <br />