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M <br />Permit ,vo: 79-45 <br />Anniversary Date: y.ebt,,,,.~ ~R <br />Operator: <br />Please complete the following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Checr..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 <br />Signed, <br />ames R. Murray, <br />ice President <br />