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~- ~ - <br />Permittee Name: Robert J Kagie <br />~ Permit No: M-79-102- <br />' Operation Name: K06G~E21I~ 86 <br />Anniversary Date: <br />. `- <br />~II ~II~I~~I~I~~~ ~I~ <br />110 and°111 Enclosure <br />•iliiU 2 ~~ iy~ <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check space(s) below) <br />Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />Annual Report <br />Remarks: /iZsL/f~t!/.ce ~c-z,-e./,p~ L¢~ .~~-~ Gic. !9~ <br />~~_ <br />~ ~~ ~/~~ <br />Fyn . s~~ " ~- <br />i ; /.c <br />