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-6- <br /> Certification: <br /> Can authorized representative of the applicant, I hereby certify that the operation <br /> scribed has met the minimum requirements of the following terms and conditions: <br /> 1. This mining operation will not adversely affect the stability of any significant, <br /> valuable and permanent man-made structure(s) located within two hundred (200) feet of <br /> the affected lands . (However, where there is an agreement between the <br /> applicant/operator and the persons having an interest in the structure that damage to <br /> the structure is to be compensated for by the applicant/operator (Section <br /> 34-32-115 (4) '(d) , C.R.S. 1984, as amended) , then mining may occur within 200 feet. <br /> Proof of an agreement must be submitted to the Office prior to the decision date.) <br /> 2. No mining operation will be located on lands where such operations are prohibited <br /> by law (Section 34-32-115 (4) (f) , C.R.S. 1984, as amended) ; <br /> 3. As the applicant/operator, I do not have any mining/prospecting operations in <br /> this state of Colorado currently in violation of the provisions of the Mined Land <br /> Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined through a <br /> Board finding. <br /> 4. I understand that statements in the application are being made under penalty of <br /> perjury and that false statements made herein are punishable as a Class 1 misdemeanor <br /> pursuant to Section 18-8-503, C.R.S 1984, as amended. <br /> Signed and dated this day of EEQ 19j24 Zae! <br /> Applicant/Operator If Corporation Attest (Seal) <br /> )CSigned: ` � Signed: <br /> < Corporate Secretary_or Equivalent <br /> )C Title: V, _e f�'S/�L'Vl� �evellj Z44V er- Town/City/County Clerk <br /> State of Polor4do ) <br /> ss <br /> County of C�r�r 0—mc-K ) <br /> The foregoing instrument was acknowledged before me this day not C-6nidr �6l <br /> , <br /> by �WL ti'&rr� LIB as y`rr �tEs'AiA i ��ralVl�'�```�f (;��n�a� ���v� �il�ry��� <br /> Nbtary Public <br /> - My Commission expires: <br /> ' ' Tatum Hudson, Notary Public <br /> == =^v State of Colorado <br /> My Commission Expires 4/512004 <br /> *Fd__"f <br /> 114194) <br />