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CERTIFICATION <br /> The Applicant, Camilletti LLC (print applicant/company name), <br /> by Darrell Camilletti (print representative's name), as Managing Member (print <br /> representative's title), does hereby certify that Moffat County (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 Fedinec Pit (operation name), <br /> File Number M-1977-057 <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 �� C-- Representative Name a, <br /> Date '`1 .> Title �f( i <br /> STATE OF6���e ) <br /> ss. <br /> COUNTY OF ) <br /> he foregoing was ackriowledged efore me thisl <br /> day of , 2045, by <br /> (l CAM as of <br /> My Commission Expires: z� 7''a�a� <br /> Notary lic <br /> DELAINE BROWN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID#20054041994 <br /> MY Commission Expires October 27,2025 <br />