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•~ <br />Permit No: 77-572 <br />Anniversary Oate: March 22 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed a/re: (Check box(es)) <br />' J~ Check or money order payable to Colorado Mined land <br />Reclamation Division for annual fees due <br />~ .~G Annual Report RECEIIVED <br />Map <br />Ml1R 2 l 1984 <br />tA1NED LAND RECLAIdAT10N OIVI310N <br />Colo. Dept. of Natural Resources <br />Remarks <br />