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CERTIFICATION <br /> The Applicant, YU/pi Q. (',unf7 (print applicant/company name), <br /> by OM in d et so r, (print representative's name), as Road • &r r. £•Prrues,-(print <br /> representative's title), does hereby certify that R e 4e AG (structure owner) shall <br /> be compensated for any damage from the proposed mining%peration 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 K t:ac4 p_y Q G C/a.isiaa-g'o A- (operation name), <br /> File Number M0.03-02 7 <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 fU0%4. COUP%7 y Representative Name <br /> Date 04.1.40.4 y Title Red 1 4 &/"i 1 £ e.ve•s <br /> STATE OF Malik ) <br /> ) ss. <br /> COUNTY OF y U.-MCC ) <br /> The foregoing was acknowledged before me this 2 I day of bruur`) , 20a'1, by <br /> _____________ as S. • e_rvksor of ytkw,a C1x -) l2 .6,-A. n• <br /> d �viclefi{_ <br /> .1161....06.—d° My Commission Expires: MA 3 1 I <br /> otary Pin• is <br /> KIMBERLY GAUL <br /> NOTARY PUBLIC•STATE OF COLORADO <br /> Notary ID#20224010584 <br /> My Commission Expires 3/16/2026 <br />