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RECEIVE 110 Enclosure <br /> No Lance & Bob Ba NOV 281996 <br /> Permitt Name: M-77-417 ND <br /> Operation Name: <br /> Permit No: Sego Mine ' MINED IA <br /> 11%01/ RECLAMATION DIVISION <br /> Anniversary Date: <br /> Please complete the following and return this form with your fees and <br /> reclamation data. <br /> Enclosed are: (Check space(s) below) <br /> XCheck or money order payable to Colorado Mined Land Reclamation <br /> Division for annual fees due <br /> XAnnual Report <br /> Remarks: <br /> ignature <br /> (I/aWF-g <br />