1995-03-23_REPORT - M1980171

• Permit No: M1980171
• IBM Index Class Name: Report
• Doc Date: 3/23/1995
• Doc Name: 110 2 ANNUAL FEE INVOICE & REPORT REQUEST
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

Permit No: 80-171
Anniversary Date: March 25
Operator:
Please complete the following and return this form with your fees and
reclamation data.
Enclosed are: (Check box(es))
Check or money order payable to the Colorado Mined Land
X Reclamation Division for annual fees due
TI Annual Report
DATE DESCRIPTI("- INVOICE NO. AMOUNT DISCOUNT DEDUCTIONS NET AMOUNT
3/14/84 SYRACUBE MLR t--i IT $0-170 $50.00-- $50.00
MINED LAND RECLAMATION DIVISI� NO 1251
1313 Sherman Street Room 421
Denver, CO $0203 DATE 31�TB b`t
[phone] n
RECEIVED FROM
f Q)"8
THE SUM OFT"" " 4-
&CC- DOLLARS $ .UO
❑C."
IK
FOR o� I� +- UdS/T�H�I HMO.
AMOUNT OF ACCOUNT......$
(+ SC ena AMOUNT RAID................$
BALANCE DUE............ ..$ BY
Signature