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-' '+7` :PT2� closure <br /> Umetco Min Corp <br /> Permittee Name: M-77-296- <br /> Permit No: King Solomon-delores <br /> Operation Name: 09 / 01 / 86 <br /> Anniversary Date: <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are: (Check space(s) below) <br /> Check or money order payable to Colorado Mined Land Reclamation <br /> Division for annual fees due <br /> Annual Report <br /> Map <br /> / // <br /> r <br /> Remarks: % he mr nes vVere o� �s czKdib4 c��f to <br /> the F?vcfr re- vea.r. Alo new crrea.S \IVere <br /> A �, urbeaP nor were- ah •r a,c. r'es reclaI �MPc� <br /> dur i n, 4 the vea. v' . <br /> Signature <br />