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v <br /> <br />Permit No: 73-7 <br />Anniversary Oate: January 7 <br /> <br />Operator: <br />Please complete the following and return this forth with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Co]orado Mined Land <br />~L_ Reclamation Division for annual fees due <br />Annual Report <br />~L. <br />.~ Map <br />Remarks <br />c . ~ ~.~.~ <br />Signed <br /> <br /> <br />