REP20738

• Permit No: M1980170
• IBM Index Class Name: Report
• Doc Name: TITLE TARGET
• Permit Index Doc Type: ANNUAL FEE / REPORT
• Media Type: D
• Archive: No

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Permit No: R(1-170
Anniversary Date: March 25
Operator:
(Check box(es))
Please complete the following and return this form with your fees and
reclamation data.
Enclosed are
X
X
Check or money order payable to the Colorado Mined Land
Reclamation Division for annual fees due
Annual Report

Remarks:
MINED LAND RECLAMATION DIVIS N 0 12 5
1313 Sherman Street Room 423
Denver, CO 80203 DArE ~~1~-~g f' L
[phone]
RECEIVED FROM
,~g~ So • 00
THE SUM OF -~ " " Y DOLLARS $ _ o~
(i-n ~e{~ $~- ~~~ daSY ~e_,Lg~JlpM ~cK
FOR ~y r///~~~'
AMOUNT OF ACC.OUNT......$ ~' { ~Qh~ ~oUI
AMOUNT PAID ................ $
$ BV
.,• DXt~ ~,~,~ ~ NO. AMOUNT DISCOUNT DEDUCTIONS NEi AMOUNT
3/14/$1+ MLR PERMIT KHEbx~IE LEVEL $0171 $50.OU" $50.00
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