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a s _ 1 • • <br />l <br />j Permit No: 77-443 <br />Anniversary Date: November 8 <br />Operator: <br />Please complete the following and return this form with your fees and <br />reclamation data. , <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />Notice of Intent to Continue t4i Wing Operations <br />Remarks <br />Signed , <br />