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PERM ITTEE/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 George C and Earlene E Hill own the following structure(s), located within 200 <br /> feet of the permitted mining area: House, Fence, Shed , «-G° <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 George C and Earlene E Hill 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 PFRMIT 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: ' V :IG � l L -� Date: <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/� !/l 'L *�y Commission Expires: riz /.1 _2z!5 -_2--.. <br /> KATHLEEN A CLEMENTI <br /> NOTARY PUBLIC <br /> NOTARY FOR STRUCTURE OWNER STATE OF COLORADO <br /> NOTARY ID 201"043949 <br /> ACKNOWLEDGED BY: MY COMMISSION EXPIRES NOVEMBER 13,2022 <br /> Structure Owner(s): George C and Earlene E Hill <br /> Signature: (_ l.G Date: "� Y <br /> Signature ' ��� ',f-r2+� Date: _ / -- � <br /> STATE OF / } <br /> )SS <br /> COUNTY OF <br /> The fore oin was ackno I d9ed before me this day of by <br /> eg&?a Public:_ �/ My Commission Expires: �('�._/ 2Da2 SOMA SILVA <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20174043659 <br /> MY COMMISSION EXPIRES OCT.19,2021 <br /> SENT TO STRUCTURE OWNER VIA CF.RTTFTED MAIL # '101811.30000165522770 <br />