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~ ~ <br />.~. <br />Permit No: 77_igq ~~I <br />Anniversary Date: NnvamhPr sn <br />f~li~!'n ~ ,,~. <br />Operator: D,~. , <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to the Colorado Mined Land <br />~ Reclamation Division for annual fees due <br />Annual Report <br />Remarks: we have not this year, and do not anticipate next year to exceed permit limits. <br />claim G i>> a tiv No reclamation planned at this time <br />Signature <br /><<~/e /Sr3 <br />~~(R <br />