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:. .4 ~ <br />• <br />C <br />Permit NO: p7_~ <br />Anniversary Date: April 22 <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 />Remarks <br />Check or money order payable to Colorado Mined Land Reclama- <br />® ti on Division for annual fees due <br />® Annual Report <br />Map <br />Signed, <br />~t~7'J~G~ ~1I. Gy~ <br />Sondra Waid, Office Manager <br />Anniversary Date is April 27, <br />