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:. - <br />110 and 111 Enclosure <br />Permittee Name: MELVIN R GYDESEN <br />Permit No: M-82-020- rh~Yl c ~~~~ <br />Operation Name: LUCKY STRIKE LODE <br />Anniversary Date: 05 / 25 / 85 <br />~ - JIU. <br />L-1 <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 />Remarks: ~,~,~,,:.., ` 9L7~2t:2~ pie-v~-~J~J, cc-~v>:~3 <br />I , /~ . / -t- i ~ -~.. s <br /> <br />~c.~-r%LL~~¢/ Lam(/ <br /> <br />MINED LAND RECLAMATION DIVI' I ~J o 3 5 6 7 <br />- -1313 Sherman Street Room 423~..i <br />Denver, CO 80203 PATE ~.r ~ ,s tz~! <br />(303) 866-3567 p <br />r C <br />RECEIVED FROM -~ <br />THE SUM OF 2 ~? ~LLARS $ 5O`l/~ <br />^ crsN <br />n _ ~ECK <br />FOR •~V- rn.0. <br /> <br />AMOUNT OF ACCOUNT...... $ <br />IlQ1`~ n'ou~ <br />A <br />`l <br />1 <br />- <br />(~J <br />J <br />AMOUNT PAID ................ $ 1. <br />BALANCE OUE ............... $ 6V <br /> <br />//~ <br />Signature <br />,S~/b (8S <br />~•~• <br />(e <br />.s- <br />