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pp <br />The Applicant, 14i t5 1.9 (1 vyJf £I t-jri : • <br />by ! et /f CC.duee (print representative's name), as <br />Z fig AAPc <br />' <br />re resentatives title does hereby certify that ""�' <br />p ), y y (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 Bulldog Mountain Operation, <br />File Number M-1977-215. <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 !CiPr& #1 <br />Date 6/7 20I L <br />STATE OF C Yak <br />) ss. <br />COUNTY OF tl@ifo• ) <br /><-12. <br />Notary Public <br />CERTIFICATION <br />NOTARY FOR PERMIT APPLICANT <br />Representative Name /�, <br />Title 'IN &Me/4 " 'er <br />The foregoing was acknowledged before me this day of 3 t.t <br />R.4 as A tkirui d Lima/1)04pr- <br />My Commission Expires: 1 L to • 261 3 <br />(print applicant/company name), <br />l411/13 (print <br />nsi.Vlc GC <br />20 by of `-a.o &va4.e. St ivi <br />