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it • <br />Permit No: 78-271 <br />~ Anniversary Date: October 30 <br />Operator: <br />i Please complete the following and return this fore with your fees and <br />reclamation data. <br />Enclosed are: <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Annual Report <br />_ hlap <br />Rema~~1~r~~~~~~////ks: ,,,,n/1i,e1. no,ean_~ n, ,1 ~'na~/ rtti ~ ~--C~"-e-r~n_ci .U~-v~p w-.t-Pd/ <br />~~l /h1 /h'1.(L ~'Y /Lt_m /D.___ /_n /r ~iw ~ ~ 1J/i~[.(L~L{.~ y~y /1 i e ~~~1~~~~ ~ <br />Signature <br />ll~/itf ~ <br />~. j~•~ <br />~ i ~~ <br />i~!p~/ 1 ~i i983 <br />fdlP!ED Ll~rt'D FCC! ~.~:'.A.T'C^' D'rrISI0i1 <br />Celo. Dept. o(~:;iurci hesaurces <br />