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r <br />~~ <br />;~ ~~, ~ ~,~ Vin; 110 Enclosure <br />L' s <br />Loukonen Brothers J A4J 1987 <br />Pettnittee Name: M-81-277 13 <br />Permit No: Loukonen Brothers P;~fN~D LAND <br />Operation Name: 01/11/87 ~ ~~ <br />Anniversary Date: ':~FC!.(1PI,,'1110N DIuIS ni <br />Please complete the following and return this form with your fees and <br />reclamation data. <br />- - - Enc'''--~}{{{)))(((o~ed are: - (Check space(s) below)- - - <br />~~~i •U <br />~~ Check or money order payable to Colorado Mined Land Reclamation <br />Division for annual fees due <br />y Annual Report <br />Remarks : ~ ~/ .(' (.t: 1 ~ ~ F o u j I ~t /u :i I G ~ ~ 'L~ ~ ~-P'~~ 'P <br />r 1 - <br />ii i~ l V -P ~ I d ~-1 vl (tn S ~ Y~ 7111 ~ : r -t t~ D-G ~ ~l ~ ~ u v~ <br />Signature <br />r/!a/a'7 <br />~. ~. <br />~~r~ <br />