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~. ~ i ~ <br />•~ <br /> <br />Permit fro: 76-7 <br />Anniversary Date: October 4 <br />Operator: <br />Please complete the following and return this fore with your fees and <br />reclamation data. <br />Enclosed are: <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />_ hiap <br /> <br />Signature <br />~j~~j~i~ <br />~~ <br />