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<br />Permittee Name: Henderson Development Company <br />Operation Name: <br />Permit No: 80-110 <br />Anniversary Date: September 9 <br />M III Illllllllllllllll <br />_ 112 Attachment <br />SAP?.F. 1~~;I.i <br />~ U'~~lllt,.LU~h3niloMLl'lJ-rry <br />- , Cf, latn <br />i'.I P^^n~~r~ <br />J <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />ly~l Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due $350 <br />I~-~ Annual Report <br />~xx ~ Map <br />Remarks: <br />Signature <br />(Rev. 5/84) <br />Doc. No. 1805 <br />