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CERTIFICATION <br /> The Applicant,'Crvstal Creek Mining,1.1.0(print applicant/company name),by Jeff Schimel,as OPERATOR, <br /> does hereby certify that USDA FOREST SERVICE(structure owner)shall be compensated for any damage <br /> from the proposed mining operation to the above listed structure(s)located on or within 200 feet of the <br /> proposed affected area described within Exhibit A,of the Reclamation Permit Application for JJ <br /> COLLECTING PROJECT#2(Redemption),(Forest service MPO: #2810-021210-MPO-2023-001) <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 /> ACKNOWLEDGED BY: <br /> Applicant =..5, - _ ,-) Representative name , E'•Ff're j Ar0 r1 c 1 1 <br /> Date 3vnie- I?i 2025'r Title Dpt,114.112 f <br /> STATE OF re S ) <br /> COUNTY OF `1'tkr re4 wtf" ) <br /> The foregoing was acknowledged before me this 1344-day of t)Qv,e, ...... _,20 its -, by <br /> J a c-tt.i ko#_' as D PGrw .0(" of e.r J Lctee-ic a-ii Terri 1.`4-_is <br /> r- - � JJ <br /> My Commission expires: 0/91)/42.7 <br /> —t y No itto.__ ___----_� <br /> :: "N' JOSE CISNEROS <br /> My Notary ID#134612276 <br /> \1%r"s•;•;.y:�' Expires October 20,2027 <br /> l <br />