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Date: <br />Signature Cover Page <br />Please include this as an originally executed cover sheet <br />with your Colorado royalty report submissions each month <br />-l3 <br />To: Colorado Board of Land Commissioners <br />1127 Sherman Street, Suite 300 <br />Denver, CO 80203 <br />Att: Minerals Section, State Land Board <br />Re: Signature Certification <br />I have reviewed the reports herein for accuracy and I certify that this is a true and correct <br />statement of production sold, value received, and royalty due the State of Colorado for <br />the current reporting period of " ` <br />Authorized Signature <br />Title <br />L 'AIINERALSIRO}ALIY1SIGN1TURF C'ERTIFIC'ATION <br />