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STATE OF <br />COUNTY OF <br />CERTIFICATION <br />The Applicant, Cotter Corporation (N.S.L) (print applicant/company name), <br />by Amory Quinn (pr representative name), as Presi dent (print <br />representative's title), does hereby certify that NSA (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 Schwartzwalder Mine (operation name), <br />File Number M -1977- 300 <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 />NOTARY FOR PERMIT APPLICANT <br />ACKNOWLEGED BY: <br />Applicant Representative Name <br />Date Title <br />The foregoing was acknowledged before me this day of <br />as of <br />My Commission Expires: <br />Notary Public <br />,20 ,by <br />