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CERTIFICATION <br /> The Applicant, Cheyenne County,Colorado (applicant/company name),by Ronald R.Smith (representative's name), <br /> as Chairman(representative's title),does hereby certify that Mattics Family Discretionary Trust/Amy Church,Trustee <br /> (structure owner)shall be compensated for any damage from the proposed mining operation to the above listed <br /> structure(s)located on or within 200 feet of the proposed affected area described within Exhibit A,of the Redamation <br /> Permit <br /> Application for Mattics Pit (operation name),File Number M-2021-044. <br /> This form has been approved by the Colorado Mined Land Reclamation Board pursuant to its authority under <br /> the Colorado Land Reclamation Act for the Extraction of Construction Materials and the Colorado Mined <br /> Land Reclamation Act for Hard Rock,Metal, and Designated Mining Operations. Any alteration or <br /> moderation to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEGED BY: <br /> Applicant: Cheyenne County Representative Name: on:. a . Smith <br /> Date: ;4-1/--(906 -1 Title: Chairman <br /> STATE OF Colorado ) <br /> )ss. <br /> COUNTY OF Cheyenne ) <br /> The foregoing was acknowledged before me this 1.114 . day of Nk\i"6" \ , 20 24,by <br /> Ronald R. Smith as Chairman of Cheyenne County <br /> My Commission Expires: ,6 <br /> Notary Public <br /> ALLISON BROWN <br /> NOTARY PUBLIC <br /> STATE OF COLORADO <br /> NOTARY ID 20234022709 <br /> MY COMMISSION EXPIRES JUNE 15,2027 <br />