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.. _ <br />~ iii iiiiiiiiiiiiiiii <br />Permit No: 80-52 <br />Anniversary Date: April 23 <br />Operator: Fern 8 Keith Holsinger <br />~~ <br />RECEIVED ~~ <br />ANR l~ 1ya4 <br />MINEp tAN4 RECIAMAiION gIVIS10N <br />Colo. DbPi uc Na~ucac desuucces <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 the Colorado hlined Land <br />_ Reclamation Division for annual fees due <br />~~ Annual Report <br />Signature <br />~ ~~ ~U <br />~~ <br />