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CERTIFICATION <br /> The Applicant, IHC Scott, Inc. (print applicant/company name), <br /> by dtis, �� (print representative's name), as V j C C PY-tS 1�&---4— (print <br /> representative's title), does hereby certify that MACWA, LLC (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- Zett- os—l. <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. Representative Namt-e-- 2s <br /> Date 115J),Z 3 Title <br /> STATE OF Id- ) <br /> ss. <br /> COUNTY OF ) <br /> The foregoing was acknowledged before m this -day of • , 201-3, by <br /> 'C, �GJ�✓1'S as �C C ��5��•..�--— of 1HC soon,Inc. <br /> r, <br /> 4 My Commission Expires: „ <br /> Nof ary Pub <br /> MITZI REECE <br /> Notary Public <br /> State of Colorado <br /> Notary ID#20184011940 <br /> My Commission Expires 05-09-2026 <br />