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-~ <br />~ III IIIIIIIIIIIII III <br />Permit o: <br />Anniversary Date: p1a~ is <br />Operator: Jake Kaufman & Son <br />f~AY ~ `~ 198' <br />f.41NED LAND RECLAMATION DIVISION <br />Celo. Dept. of Natural Resources <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />Enclosed are: (Check box(es)) <br />Check or money order payable to Colorado Mined Land <br />Reclamation Division for annual fees due <br />~ Annual Report <br />Map <br />Remo/rks ' 77e ~~ ~--.e_, D~~~ . ~~c.. ~~ . aif'u~.z}' ~/u L4~.~.d <br />lG~e~{~-.:q •~ ,E-'u1~r »z.e~.".e~ ~.Lf~ ter',-2 ..~.~-.c~.~~c' .-~'z~L <br />~17.e~ -e~c...-e.e~i ~-u~.s~c.~J d~ Gt~aeQ. ~.1,G-e~L``~J <br />~~ -~.Gb~-St<.~~.~,..~ ,~1Flµi r-ir.~~ii ~ft~r~-tom <br />Signed <br />