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CERTIFICATION <br /> The Applicant,Crystal Creek MiritgjLLC(print applicant/company name), by Jeff Schi►nel,as OPERATOR, <br /> does hereby certify that USDA FOREST SERV►C.E(structure owner)shall he 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 o Construction Materials sand <br /> the Colorado Mined Land Reclamation Act for Hard Rock,,Metal, and Designated Mining Operations. <br /> Anyalteration or modification <br /> to this form shall result in voiding this form. <br /> NOTARY FOR PERMIT APPLICANT <br /> ACKNOWLEDGED BY: <br /> fr <br /> Applicant_c� � ._.i4�� -_._..-) Representative name )e f{'re) i qf'pA—SCL14,4/ <br /> Date 3.1/ra a J, 20 2 S� Title pt',/ i LL <br /> JLIl_...-.. <br /> STATE OF rexci,S <br /> COUNTY OF `TrArer.4iv ) <br /> The foregoing was acknowledged before me this 1344"day of �?u�Q _,20 ?S , by <br /> as ►l aG4xirl7 f of Nsici <br /> My Commission expires: _J' p1�'?�,27 <br /> Notary t <br /> ..,�.�..±.+... <br /> +'+a~. JOSE CISNEROS <br /> . A . .; My Notary ID#134612276 <br /> ...Y: <br /> ".:sr.;•:'•�` Expires October 20,2027 <br />