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.~ <br />Permit (VO: 80-135 <br />Anniversary Date: ~CtOb21' <br />Operator: <br />Please complete the following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land Reclama- <br />ti on Division for annual fees due <br />Annual Report <br />Map <br />Remarks <br />~~ ~ ~ <br />-T <br />,~2y~.'_Z.~C,i'fJJ c f <br />Si g d, -^t~j ""j" - `ry ~~C- <br />~~ <br />~v~-D.~ <br /> <br />~~ ~. <br />~~ _ <br />. ~~~ _ ~ ~ <br />,~~:d~.~ lewd ~~,.,~~ .~=~ ~~~- ~ <br />