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Proof of Filing with County Clerk <br /> x5a <br /> lt10`tctiS� <br /> 1, Ccr the 6,':Y� for ryi on-��o County; <br /> �� have received a application package for a Hard Rock/Metal Mining Limited Impact (1l0) <br /> Reclamation Permit with the Colorado Mined Land Reclamation Board under prov'sions of the Colorado Min d <br /> ` Land Reclamation Act. The proposed mine is known as the(Name of the Mine) S <br /> and is located at or near Section Township ,Range , Principal Meridian. <br /> tea_() <br /> Signature Date <br />