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PERM ITTE E/STRUCTURE OWNER AGREEMENT <br /> Mine: Native/Pierre Mine -M-1977-321 <br /> State of Colorado, Mined Land Reclamation (MLR) law requires the permit applicant(operator/permittee)to agree <br /> to reimburse the owner of any permanent man-made structure(s)within 200 feet of the permitted mining area, for <br /> damage done to the structure(s) as a result of the permitted operation. <br /> Summit Brick and Tile Co. believes Steve R&Janet Pena own the following structure(s), located within 200 feet of <br /> the permitted mining area: House <br /> Summit Brick and Tile Co. agrees to reimburse you for any damage done to the listed structures as a result of the <br /> mining operation. Your acknowledging signature and a notary seal in the spaces provided below shall satisfy the <br /> MLR law requirement. Summit Brick and Tile Company certifies this agreement as follows: <br /> CERTIFICATION: The Applicant Summit Brick and Tile Co. represented by Matthew R. Welte as CEO, does <br /> hereby certify that Steve R&Janet Pena shall be compensated for any damage from the proposed mining <br /> operation to the above listed structure(s) located within 200 feet of the permitted mining area described in the MLR <br /> Permit for the Native/Pierre Mine. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> Permit Applicant: Summit Brick and Tile Co. P.O. Box 533 Pueblo 81002 <br /> Representative: Matthew R. Welte CEO- 719-542-8278 <br /> Signature: 14l d&y t t_ C 4 ��� Date: J <br /> STATE OF Colorado ) <br /> ) SS <br /> COUNTY OF Pueblo ) <br /> The foregoing was acknowledged before me this day of 2020, by <br /> Matthew R.Welte as CEO of Summit Brick&Tile CO. <br /> Notary Public����% '� `G- ZMy Commission Expires: <br /> KATHLEEN A CLEM k I <br /> NOTARY FOR STRUCTURE OWNER NOTARY PUBLIC <br /> STATE OF COLORADO <br /> ARY ID 20144043949 <br /> ACKNOWLEDGED BY: MY COMMISSION T EXPIRES OVEMBER 13 2022 <br /> Structure Owner( : Steve R&J Pena <br /> Signature: ____-_—.-- Date: <br /> Signature: '� _ Date: Q'-1) !-e� <br /> STATE OF <br /> 1 t 1-1i ) SS <br /> COUNTY OF ) <br /> The foregoing was acjknowledgeAbefore me this rti day of 20�, by <br /> -j A �u QI KRISTIN A BOWER <br /> Notary Public: dA.-My Commission Expires: 3 NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20114036291 <br /> MY COMMISSION EXPIRES JUNE 9,2023 <br /> SENT TO STRucTuxs OWNER VIA CERTIFIED MAI(. # 70192970000082391264 <br />