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Page 2 of 5 <br /> Return the enclosed Annual Report FORM, a MAP, and a CHECK or MONEY 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 /> If you have additional comments and/or information that should be provided to the Division,please provide <br /> it below or attach it to this form along with your written report and map. Annual Report instructions are <br /> enclosed. If you have any questions, please feel free to contact Scottie Tate ((303) 866-3567 ext 8166), <br /> Michelle Ramirez((303)866-3567 ext 8114),or email dnr_drmsminadmin@state.co.us. Thank you for your <br /> cooperation in this matter. <br /> iI" 1111 \\NL "\[ i I-1\111"1 AI ti \t)i i) ()N tilt 1tI Ft}[fit" ) 01•R <br /> \\\l\ 1:R`—\R ).\ IL I lir 1,\i"010'1 Nit NI 1'R()t"1". \\ ILI" At it)\I \ 1 I;'Ai <br /> I I ` I I:1) I'\! ( 1K( I MI \ I \l 110V; \I t1' RI,til"I IN t, I\ II 1'I \,tl HI i ltii; t tiz <br /> RI 4"(( IONfit' 1t`1 K K11[ <br />