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,_ ~. • • / <br />RECEIVED <br />Permit ivo: 77-317 <br />Anniversary Date: DE!CE!mbE!T' 15 JAN 0 31983 <br />MINED LAND RECLAMATION <br />COLO. DEPT. OF NATURAL RESOURCES <br />Operator: <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Tand <br />Reclamation Division for annual fees due <br />Annual Report <br />Remarks <br />signed, <br />i <br />,isi~3~' <br />Cm ~' r~-~ <br />~ ~ <br />~~~~ fi~~i <br />