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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 Alfred Don and Deborah Jean Rodriguez own the following structure(s), <br /> located within 200 feet of 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 Alfred Don and Deborah Jean Rodriguez shall be compensated for any damage from the <br /> proposed mining operation to the above listed structure(s) located within 200 feet of the permitted mining area <br /> described in the MLR 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: l�� � � �y ���� �� Date: <br /> STATE OF Colorado ) <br /> ss <br /> COUNTY OF Pueblo ) <br /> The foregoing was acknowledged before me this day of z2yzz, 2020, by <br /> Matthew R.Welte as CEO of Summit Brick &Tile CO. <br /> Notary Publi 'L //' " . My Commission Expires- <br /> KATHLEEN A CLEMENTI <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): Alfred Don and Debora an Rodriguez _ <br /> Signature:_ �.�-�' ,� '..�c� Date: <br /> Signatur� J Date: � ( <br /> STATE OF r'Ct•`I Q_ ) <br /> ) ss <br /> COUNTY OF F ) <br /> T e foregoing was ackno ledged before me his ��l day of ,20)0, by <br /> LA CIL, <br /> Notary Publi My Commission Expires: I i D-o car <br /> ROCHELLE CRUZ <br /> Notary Public <br /> State of Colorado <br /> Notary ID M 20064001321 <br /> M Commission Expires 0l-11-2022 <br /> SENT TO STRUCTURE OWNER VIA CERTIFIED MAIL If7019?.970000081.391.301 <br />