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.. ~ •~ <br />Permit No: 77-424 <br />Anniversary Date: May 24 <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 />Che~•k or money order payable to Colorado Mined Land Reclama- <br />~, ti on Division for annual fees due <br />Annual Report <br />Map <br />Remarks <br />P <br />Signed, /~2~f~•rv//~Gf~ <br />