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~. ~ V .. <br /> <br />Permit No: 77-170 <br />Anniversary Date: October 1 <br /> <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 />Q ti on Division for annual fees due <br />Annual Report <br />Map <br />Remarks Noted on the letter - a new map will be available <br />in 10 days <br />Signed, <br />~. ~ , <br />