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III IIIIIIIIIII~~ III <br />Permit No: 78-327 <br />Rnni versary Date: May 14 <br />~~ <br />~~~~~~~~ <br />Jl.'iV 81982 <br />MINED LAND H[CLAINATIUN <br />Colo. Dent. of !Natural Rvsource~ <br />Operator: <br />PZease complete the following and return this form with your fees and reclama- <br />tion data. <br />Enclosed are: (Check box(es)) <br />'P -- - --- - -- - - - ~ -- <br />fi 3 (i~ Check or money order payable to Cclorado Mined Land Reclama- <br />ti on Division for annual fees dve <br />Rnnual Repor*_ <br />Map <br />/ i / <br />Remarks (.~~1 ~~.-.~,~ ~O ~/ CJ ,:-yz.~-cam-f ~,._y ~c -/o -A/ n~/~.. -~~i <br />~ ~9 9 k _ ,a~,~a..e. C~-a~--,....t-c.~ ~i a~./ „mac-utiY~c./ <br />Signed, `s~/~ ~~~~~,,~ <br />--~-~-~-d--.~ ~ 1 <br />L. ~ 7 - /SSJ <br />