Laserfiche WebLink
+ iii iiiiii-iiiiiuiii1 • <br />999 <br />__ <br />Permit No: 81-6 <br />Anniversary Date: Rpril 27 <br />Operator: <br />Please complete the feZlowing and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es!J <br />Check or money order payable to Colorado Mired Land Reclama- <br />ti on Division for annual fees due <br />Rnnual Report <br />Map <br />Remarks <br />/J <br />MI <br />Co!~ <br />Signed, <br />