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MOFFAT COUNTY CLERK AND RECORDER <br />File Number <br />Drawer Number <br />Return Date <br />Received <br />Mailing Aaoress <br />221 W. Victory Way <br />Craig, CO 81625 <br />(970) 824-9104 <br />MINING/ RECLAMATION FORM <br />Mining -and Reclamation Application for: � y <br />Name of Pit or mine: Ute` <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: <br />I <br />Agent Signature: <br />For: <br />Attest: County Clerk or Deputy: <br />