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<br />112 Attachment <br />Permittee Name: Colorado Lien Company <br />Operation Name: <br />Permit No: 78-93 <br />Anniversary Date: July 28 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~I <br />'~! <br />1_i <br />Remarks: <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />Map <br />RECEIVED <br />JUL 18 1984 <br />MINED UND RECLAM~rIDN DivrsreN <br />Colo. Dept. of Natur~i ife-6u;,,~y <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />