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~' <br />Permit No: 81-57 <br />Anniversary Date: ,Tune 10 <br />Operator: <br /> <br />Please complete the following and return this form with your fees and reclamation <br />data. <br />Enclosed are: (Chet: box(es)) <br />Check or money order payable to Colorado .Mined Land <br />~~ Reaclamation Division for annual fees due <br />Annual Report <br />Signed, <br />~~~~~'~l~~~ <br />J'.'N 1 ~ 198Z <br />MINED LAn!U HECI Ai,h„IIDN <br />Cola. Depi. of Naluraf ~lesuurre~ <br />