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The Applicant, Baca County (print applicant /company name), <br />b Troy Crane (print representative's name), as Commisssioner (print <br />representative's title), does hereby certify that Pipe Springs Ran LLC (structure owner) shall <br />be compensated for any damage from the proposed mining operation to the above listed structure(s) <br />located on or within 200 feet of the proposed affected area described within Exhibit A, of the Reclamation <br />Permit Application for #18 Pipe Springs Ranch LLC <br />File Number M -82 - 029 <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 of Construction Materials and <br />the Colorado Mined Land Reclamation Act for Hard Rock, Metal, and Designated Mining Operations. <br />Any alteration or modification to this form shall result in voiding this form. <br />ACKNOWLEGED BY: <br />Applicant g c, o.. Co. t) Y J 7 <br />Date /O//7 /1 / <br />STATE OF C fd- ) <br />) ss. <br />COUNTY OF 6 HC Fl ) <br />y_ // 6 ,, <br />The foregoing was acknowledged before me this / / day of 0 0 - 1 , 20 / / , by <br />f D � ara h-e as Cou ri I inm ssic3oerof &Act ('n r.r <br />Notary Public <br />CERTIFICATION <br />NOTARY FOR PERMIT APPLICANT <br />Representative Name l <br />My Commission Expires: /D-- /8 - n / £ <br />(operation name), <br />Cra v e- <br />Title co achtJ 41 a2 / S'S / v <br />