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CERTIFICATION <br /> The Applicant, Mineral Adventures LLC (print applicant/company name), <br /> by Robert H Jennings (print representative's name), as Managing Member (print <br /> representative's title), does hereby certify that US Forest Service (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 Tenpercenter Claim (CMC254209) (operation name), <br /> File Number M-2018-036. <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: p r <br /> Applicant MIWI4L fiPVaMC,5 ` CRepresentativeName <br /> Date ��e 7 Z Title AvirouV6 <br /> STATE OF /LUG ,✓ ) <br /> ss. <br /> COUNTY <br /> The fore oin was acknowledge before me his 2 day of cal�' , 20�by <br /> as an r1 Fn.Gey of 1 0f v/oS LL� <br /> i My Commission Expires: <br /> Notari NblIc <br /> OFFICIAL STAMP <br /> *COMMISSION <br /> MARTHA MARALIT KING <br /> NOTARY PUBLIC-OREGON <br /> NO. 1018983 <br /> MYCOMMISSION EXPIRES NOVEMBER 11,2025 <br />