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~- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation descnbed has met the minimum requirartents <br />of the following terms and conditions: <br />1. To the best of my kttowiedge, all signifKant, valuablcand pemtarteatman-made structure(s) in existence at the lino this <br />application is filed, and located within 200 feet of the proposed affected area have bey identified in this applcation <br />(Sedion 3432.5-115(4)(e), C.RS.). <br />2. No mining operation will be located ~ lands where such operations are pmMbited by law (Section 3432.5-1 IS(4xfj, <br />C.RS.; <br />3. As the applicmUoperator, I donut have any extraction/explaration operations in the State of Colorado currently in <br />violation of the provisions of the Colorado Land Reclamation Ad for the Extraction of Conshucdon Materials (Section <br />34-32.5-120, C.RS_) as determincd through a Board finding. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are punishable as a Class 1 misdemeanor pursuant to Section 18-5-503, C.RS. <br />Signed and dated this 17~ day of ~ 2~ <br />Willits Com ny, In . <br />Applitand or Comp Name <br />i <br />Sigtted; <br />Title: President <br />Corporatc <br /> <br /> <br />t'Atttst (Se~ <br />to <br />~ ~ <br />~:9N ~ :' <br /> <br />or <br />Town/City/County Clerk <br />State of Colorado <br />ss <br />Cotmtyof Jefferson t <br />The foregoing urstnmtent was aclmowledged before me this / 7 ~ day of ~`' E 8~+/rt•P-r Z oo ~ , <br />by 2c73EarC. GCJrr.r.rT3 as P~«.: of ttJrr.t+(r3 ~orkPa~f' /Nc <br />~OTARy 92, <br />P`. «9' ~~ <br />... i Notary Pubhc <br />pUB L\C. A~~~ My Commission expires: / ~~/B/Zoos <br />SIGN~Y~1r3"14IUST BE IN BLUE INK <br />M.'~hndMarm17i27C0iS.APP (07117/SOW) <br />