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MOFFAT COUNTY CLERK AND RECORDER <br />221 W. Victory Way <br />Craig, CO 81625 1 <br />(970) 824-9104 <br />MINING/ RECLAMATION FORM <br />Fife Number <br />i <br />Drawer Number <br />I <br />Return Date � <br />Received <br />Mailing Auure55 <br />Mining+and Reclamation Application for: <br />Name of Pit or mine: <br />Date on which inspection period is over and application may be retrieved by <br />Applicant: <br />Agent Signature. 21'z&�� <br />For: <br />Attest: County Cleric or Deputy: <br />