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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)(0, <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 5TH day of MAY <br />2011 <br />JUBILEE VENTURE, LLC <br />Applicant/Operator or Company Name <br />Signed. <br />Title: MANAGING PARTNER <br />State of <br />t???%y1G '/ ) <br />County of <br />)s <br />If Corporation Attest (Seal) <br />Signed: <br />Corporate Secretary or Equivalent <br />Town/City/County Clerk <br />The foregoing instrument was acknowledged before me this day ofiT! ??? <br />b9 .4uN-Z as ofd` <br />P 0ALFe ,z/ -J <br />-\!I' OTAR NO Public <br />-#- r O My Commission expires: 1?-- <br />A SIG PLAT MUST BE IN BLUE INK <br />-p?PUgl..! : <br />161 <br />OF C OHO <br />36P0 ?? <br />MY Commm• Expires