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i <br />~ ~ ~ <br /> <br />PetmZt tdo: 80-136 <br />Anniversary Date: February 25 <br />Operator: <br />Please complete the following and return this form with your fees and reclama- <br />ti on data . <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado ~~fined Lard P.eclama- <br />ti on Division for annual fees due <br />Annual Report <br />r~ra p <br />Remarks <br />Signed, <br /> <br />