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<br />112 Attachment <br />Permittee Name: Fremont <br />Operation Name: <br />Permit No: M-80-224 T <br />Anniversary Date: January 6th or October 27th?-(per M.L. R.D.) <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />~X~ Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~~ Annual Report <br />~~ Map <br />Remarks' Anniversary date as yet undetermined by M. L. R. D. <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />