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Street Street <br /> P. o> tv.o> Br- <br /> 2-7P.O. Box P.O. Box <br /> /Y4f4ri'�'4 � G'U f'/�LZ Uct✓ G� / S� <br /> City,State,Zip City,Stat ,Zip <br /> ( 9?a ) l��� Z�'f'G ( 97-0 ) 3'B- 1443a <br /> Telephone Telephone <br /> ( ) ( ) <br /> Fax Fax <br /> 4. APPLICATION FEE: $86. (NOIs require an $86 fee which must accompany this notice <br /> or it cannot be processed by the Division). <br /> 5. <br /> LOCATION INFORMATION: <br /> County: <br /> M�.fry se <br /> Principal Meridian (check one): <br /> ® 6th (Colorado) rr--p, loth Ute <br /> 1110 (New Mexico) E-1 <br /> Section (write number) TOWNSHIP N S <br /> RANGE E <br /> -] <br /> Jg FW [a Tkis locafeM Z. <br /> QUARTER SECTION (check one); <br /> girl- 3 <br /> NE tn., NW E] SE ® SW F] AVel JVW J 33 T9.7A/, Ql 7 W <br /> QUARTER/QUARTER SECTION (check one): <br /> NE Ef NW SE [] SW <br /> GENERAL DESCRIPTION: (the number of miles and direction to the nearest town and the <br /> approximate elevation): <br /> �p•'bYl�1JG a%. /7 AA��iWetT O���f./LLI�'f�Q Gb -Q ' <br /> Form 1 <br /> Page 2 of 14 <br />