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-8- <br />Certification: <br />As an authorized representative of the applicant, I hereby certify that the operation described has met the minimum requirements of the <br />following terms and conditions: <br />1. This mining operation will not adversely affect the stability of any significant, valuable and permanent man-made <br />structure(s) located within two hundred (200) feet of 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 the structure is to be compensated for by <br />the applicant/operator (Section 34-32-115(4)(d), C.R.S. 1984, as amended), then mining may occur within 200 feet. Proof of <br />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 by law (Section 34-32-115(4)(f), <br />C.R.S. 1984, as amended); <br />3. As the applicant/operator, I do not have any mining/prospecting operations in this state of Colorado currently in <br />violation of the provisions of the Mined Land Reclamation Act (Section 34-32-120, C.R.S. 1984, as amended) as determined <br />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 18-8-503, C.R.S 1984, as amended. <br />This form has been approved by the Mined Land Reclamation Board pursuant to section 34-32-112,C.R.S., of the Mined Land <br />Reclamation Act. Any alteration or modification of this form shall result in voiding any permit issued on the altered or modified <br />form and subject the operator to cease and desist orders and civil penalties for operating without a permit pursuant to <br />section 34-32-123, C.R.S. <br />Signed and dated this ?? 3 1 day of 1Y1'a_yC r( 2011 <br />Mt. Elbert Mining Co., L.L.C. If Corporation Attest (Seal) <br />Applicant/Operator or Company Name <br />Signed: ' - <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />Title: Manager <br />State of 44_7_' <br />ss. <br />0 <br />County of 1 <br />The foregoing ins ment was acknowledged before me this 3/ day of " C IL*' by ?d'? as of e ??C e,0 LL /? <br />l? <br />?OtpQy P4 9 <br />Sylvia N ary Public <br />M. <br />My Commission expires: <br />v'l. H00 OD SIGNATURES MUST BE IN BLUE INK <br />commiwWwom