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<br /> <br /> <br />,. ~~ <br />Permit No: 80-203 <br />Anniversary Date: June 29 <br />~U,! 2 0 l°83 <br />~Ili~?ED LA1~'.D ~LGLA~VI,~7I0~1 <br />Colo. Deft of I~latur,l Resnr!rce` <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />X Check or money order payable to Colorado ±+lined Land <br />_ Reclamation Division for annual fees due <br />x Annual Report <br />Remarks: <br />~~l,Ritl~-r-n ~ ~'~ <br />Signature Carleton Currier, Operator <br />