Laserfiche WebLink
~. <br /> <br />Permit No: 81-158 <br />Anniversary Date: <br />Janu,sry 26 <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 />Check or money order payable to the Colorado Mined land <br />Reclamation Division for annual fees due <br />_ Annual Report <br />Remarks: 7~~ ,~ ,:,~-~r~ ilo r~.;,,~~ c/LPr~~~'o.,r i~ /Y Xj. <br />n /%ffSR i~.e n..~ r,,,fT~~ Sr,rr i ~ fl.~.~ w, ~! l <br />~/ <br />~ iii iiiiiiiiii~ii iii ~ <br />iii. •= <br />Signature <br />