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Cerdfpdiou: <br />As an authorized repceseatative 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(4Xd), 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(4xf), <br />CRS. 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, CRS. 1984, as amended) as determined <br />through a Board fording. <br />4. I understand that statements in the application are being made under penalty of perjury and that false statements made <br />herein are perishable as a Class I 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- 11Z,CR.S , of die Mined Land <br />Redesnationdles. Any alteraden or m.dificadan of this form shall result in voiding an y permk issued on the akered or wended <br />form and subject the *pastor to cease and desist orders and civil penalties for operating without a permit penman: to <br />section 34-32 -123, C.R.S. <br />Signed and dated this 8 th day of March <br />Rio Grande Silver, Inc. <br />Applicat Company Name <br />Signed: _ A �Ec <br />Title: General Manager <br />State of 0..010 Aeh) <br />-8- <br />2013 <br />�• ) <br />County of gI�tL QL ) ) ' <br />day of <br />The foregoing in was aelmowledged before me this _ 4 <br />A_ r <br />by <br />Men! kW! ?J as Agetia of geaVs4t2ti a'; Nell' inc <br />KASSIDY R. MANKOWSKI <br />NOTARY PUBLIC <br />STATE OF COLORADO <br />NOTARY ID: 20094000388 <br />MY COMMISSION EXPIRES January 16, 20 <br />�' d `fila2Lo,Gc0 <br />Lary Public( <br />My Commission expires: L l l <br />TURES MUST BE IN BLUE INK <br />