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CERTIFICATION <br />The Applicant, Kit Carson County <br />(print applicant /company name), <br />by David L Hornung (print representative's name), as Chairman (print <br />representative's title), does hereby certify that Elsie J Walters Trust (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 Beeson Pit <br />File Number M -82 -186 <br />(operation name), <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 (Lc (� ((��� t, Representative Name , �l 1 (_ 1 L LL k' n L; 11 G <br />Date `ll'?a 2 C Title <br />STATE OF <br />ss. <br />COUNTY NTY OF "' ) <br />The foregoing was acknowledged before me this day of �� J <c , 20r-3, by <br />as�t'1Cii /t)r4yl of �� ,(�c��!�c� -� (c';i <br />/ �, AL--1 My Commission Expires:��c�', <br />64a ry Public <br />L -� <br />PAULA S. WEEKS <br />NOTARY PUBLIC <br />STA' E OF CULOrAOO <br />NOTARY ID 2U'84027129 <br />MY COMMISSION EXPIRES AUG. 20, 2016 <br />