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A <br />i I~~e fl All <br />Permit No: 81-44 <br />Anniversary Date: Apr•i 1 7 '~ ~ ~ ~" i ' <br />Operator: Vida S. Solberg __~,,r-.•.,f ._:_r_I.._:c_~rc.~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />R Check or money order payable to the Colorado Mined Land <br />~ Reclamation Division for annual fees due <br />Annual Report Will Mail to you on or before April 20th <br />Remarks: <br />L ~ / <br />Signature <br />~~// ~~ ~` <br />~. ~~- <br />I" i (~ <br />~~' <br />