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.,. <br />Permit No: 78-116 5M-18 Kline <br />Anniversary Date: October 31 <br />n <br />U <br />Operator: <br />Please complete the following and return this fore with your fees and <br />reclamation data. <br />Enclosed are: <br />!' Check or money order payable to Colorado Mined Land <br />_ Reclamation Division for annual fees due <br />~! Annual Report <br />hlap <br />Remarks: ~~ ~ d/ ~/~~ <br />Signature <br />