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Permit No: 81-44 <br />Anniversary Date: .4pri1 7 <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />m Z t+ra q t <br />Enclosed are: (Check box(es)) <br />~,~ ,~. 1 ' 1932 <br />Check or money order payable to Colorado 'J Hf `.~~ R,° ~~~. ~ ~~~ ~ <br />Reclamation Division for am ual fees due C; 010. i]ept. Ui ~\~~.GfJ{ .{DSUI~iCP° <br />Annual Report <br />~rl{~~~y <br />~`~~ Remarks <br />~' ~ ) <br />t <br />Signed, ~{~~, ~-~ L~k-c~ <br />G!~ ~.~u z ~~{L. - <br />/~c~pJl <br />