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CERTIFICATION <br /> The Applicant, A C V 0, 6L L C- (print applicant/company name), <br /> by �� CW S 1'� V" (print representative's name), Manager riot <br /> representative's title),does hereby certify that �� V R 14 3 L I LC-� � (structure owner)shall <br /> be compensated for any damage from the proposed mining operation to the above listed structure(s) <br /> located on or within 200 feet of the proposed affected area described within Exhibit A,of the Reclamation <br /> Permit Application for GU N N ELL MINE (operation name), <br /> File Number M- <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its <br /> authority under the Colorado Land Reclamation Act for the Extraction of Construction Materials and <br /> the Colorado Mined Land Reclamation Act for Hard Rock,Metal,and Designated Mining Operations. <br /> Any alteration or modification to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant 011c KJA Representative Name <br /> D itle e CO <br /> STATE OF a-) <br /> COUNTY OF t'l G�} ss <br /> The foregoing was acknowledged before me this / day of.��,20_,�2,!,by <br /> 7w1 as COU of OACtL <br /> y Commission Expires: 2-3// 1 w 2�M <br /> Notary Pub is <br /> _e- <br /> KIMBERLYA DUN <br /> SON <br /> Notary Public•Arizona <br /> _ Pima County <br /> + ' Commission M 584606 <br /> �• My Comm.Expires May 23,2024 <br />