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CERTIFICATION <br /> The Applicant, IHC Scott, Inc. (print applicant/company name), <br /> by �466*r" (print representative's name), as Ul C( (print <br /> representative's title), does hereby certify that Shane Collett (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 Collett Property Borrow Area (operation name), <br /> File Number M- 14-7& pv . <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 IHC Scott, Inc. <br /> pp Representative Name o`er <br /> Date kj 2eZ3 Title <br /> STATE OF 0 <br /> ss. <br /> COUNTY OFG ) <br /> The foregoing was acknowledged be. k fore me this � day of J�. , 20?3, by <br /> Tk1A 1N'►�"`7 as V a, C p rti4--k- of 1HC Scott,Inc. <br /> 44 My Commission Expires: -G J-(-0 <br /> Nothy Public <br /> MITZI REECE <br /> Notary Public <br /> State of Colorado <br /> Notary ID#20184011940 <br /> My Commission Expires 05-09-2026 <br />