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PERMITTEE/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 Bonnie Goehringer own the following structure(s), located within 200 feet of <br /> the permitted mining area: House, Fence <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 Bonnie Goehringer shall be compensated for any damage from the proposed mining operation <br /> to the above listed structure(s) located within 200 feet of the permitted mining area described in the MLR Permit <br /> 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: Alkdgtj, �(.,(✓�f Date: 5 5 ZG <br /> STATE OF Colorado ) <br /> )SS <br /> COUNTY OF Pueblo ) <br /> The foregoing was acknowledged before me this day of ze2020, by <br /> Matthew R.Welte as CEO of Summit Brick&Tile CO. <br /> Notary Public-I_IkAe.-� �!�. my Commission Expires: �- <br /> KATHLEEN A CLE�—'� <br /> NOTARY PUBLIC <br /> NOTARY FOR STRUCTURE OWNER STATE OF COLORADO <br /> NOTARY ID 20144043949 <br /> ACKNOWLEDGED BY: MY COMMISSION EXPIRES NOVEMBER 13,2022 <br /> Structure Owner(s): Bonnie Goehnn er <br /> Signature: --~- Date:_ ?`' <br /> STATE OF nj - ) <br /> ) SS <br /> COUNTY OF C��atL ) <br /> The foregoing was acknowledged before me this 46"-day of �j L0C 20 W by <br /> Notary Public: ,My <br /> Commission Expires: viCKlc L avALLA E <br /> Notary Public <br /> State of Colorado <br /> Notary ID M 2 001 401 6626 <br /> -My Commission Expires 06-05-2021 <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL If 70192970000082391400 <br />