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Page 2 of 5 <br /> Return the enclosed Annual Report FORM, a MAP,and a CHECK or MO,yEY ORDER made payable to: <br /> Division of Reclamation, Mining and Safety, 1313 Sherman St., Room 215, Denver. CO 80203. If your <br /> records indicate these documents and fees have already been submitted,please notify the Division. <br /> ae }vii iisi'v'i fell iinri..ri➢<u ui%iiiiiiC�ii��:a�i(i%i„ n ,.,,re.auwi ee.ue nun +.v.r i:a, j�ii%�r .1 <br /> Fr<_Stu♦ <br /> it below or attach it to this form along with }our written report and map. Annual Report instructions are <br /> -enclosed If you have any qUestinns.-ptea_se-feel_freeto_contant_Scottie Tate ((303) 866-31-567 ert 8166)= <br /> Michelle Raniia•ez((303)866-3567 e:Kt 8114).or ernail dnr_drmsiiiinadniiti,'�z state.co.tis. Thank you,cr your <br /> cooperation in this matter. <br /> 11' '4'(i 'NN i ♦ 4 I11:: L "i"" -11- ' " ( A -T- NOT <br /> i�i'"l�i`4l'➢`iY \i ! T_t 11I14 T;l�i <br /> it t tI tAlNiNL rZt, t t,l 7rvJn,Vl�3 r�>. + f�stt � i t�r,� t,t v L:L) ON r) IS1,AA)rU_ t T A, <br /> �.•R'!11l�nC 1,�l\� T� �'1`1^ 'r`T!T' T'\r .fl^.>-a-`S iT'i'"F ,1!l f•l..,..L•(' S\'IT 1 1 "7`f\*,S <br /> 1"'t 1 ' 1 1 { • I-I( •>r .r:1,i. -�w 1 fl t_.: , t 1� I � s ii IN a 1 •a_ti.; +S r•slr •4.-` <br /> 1.\S 15:1IS_! 1. V1 _!l\'•. �r_43 ..V ��a fIl � ,�l.'� j Lll. .� l.) i�� C . t1l. �i_)�V;"]S. <br /> REVOCATIO'Nt OF YOUR YERNMIT. <br />