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<br />110 Enclosure <br />Permittee Name: Jelen & Son Inc <br />Permit No: M-R3-011 <br />Operation Name: Willow Creek Mine <br />Anniversary Date: 02/23/87 <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: {Check space{s) below) <br />,~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due ($50,00 check ;p16776) <br />Annual Report <br />Remarks: 1986 - performed sailing, drilling and assessuent <br />c <br />Signature <br />